Table 2. Lipid recommendations for CVD patients.
| Guideline identifier, year (Ref. #) | Fasting sample | Lipid lowering targets* | Statin use recommendations | Non-statin therapy | |||
|---|---|---|---|---|---|---|---|
| LDL-C | Non-HDL-C | High intensity | Moderate intensity | ||||
| NICE1, 2014 (17) | 0 | – | >40%↓ | Atorvastatin 80 mg (simvastatin 80 mg, atorvastatin 20–80 mg; rosuvastatin 10–40 mg)* | Secondary choice†† | Ezetimibe; do not combine FAD, NC, BAS and O3FA with secondary prevention | |
| AHA1, 2018 (18) | +# | ≥50%↓ or 30–50%↓¶ | – | Atorvastatin 40–80 mg; rosuvastatin 20–40 mg | Secondary choice†† | Ezetimibe, PCSK9 inhibitor, BAS‡‡; FAD, NC§§ |
|
| ESC1, 2016 (19) | – | Very high-risk: <70 mg/dL or >50% ↓§ | Very high-risk: <100 mg/dL* | Recommend** | – | BAS, ezetimibe, PCSK9 inhibitor‡‡; FAD for TG >200 mg/dL, n3FA §§ |
|
| AACE, 2017 (2) | + | Extreme-risk: <55 mg/dL; very high-risk: <70 mg/dL |
Extreme-risk: <80 mg/dL; very high-risk: <100 mg/dL |
Recommend** (high intensity statin recommended for individuals at extreme risk)* | Ezetimibe, PCSK9 inhibitor‡‡; BAS, FAD, NC§§ | ||
| CCS1, 2016 (20) | 0# | <77 mg/dL or >50% ↓ | <100 mg/dL (ApoB <80 mg/L) | Recommend** | BAS, ezetimibe, PCSK9 inhibitor, not recommend NC, FAD‡‡ | ||
| NLA, 2015 (21) | 0# | Very high-risk: <70 mg/dL | Very high-risk: <100 mg/dL (ApoB <80 mg/L) | Recommend** | BAS, ezetimibe, FAD, long-chain O3FA, and NC‡‡ | ||
| IAS, 2014 (22) | +‡ | <70 mg/dL | <100 mg/dL | Recommend** | BAS, ezetimibe‡‡; FAD, NC, or high doses of n3FA§§ | ||
| ESC2, SCAD, 2013 (23) | + | – | – | Recommend** | – | ||
| ESC3, NSTE-ACS, 2015 (24) | – | <70 mg/dL or >50% ↓* | – | Start and maintain it: (atorvastatin)* | – | Ezetimibe‡‡ | |
| ESC4, CVD, 2016 (25) | – | Very high-risk: <70 mg/dL or >50% ↓§ | Very high-risk: <100 mg/dL* | Recommend## | – | ||
| ESC5, STEMI, 2017 (26) | 0† | If baseline is 70–135 mg/dL, then to <70 mg/dL or >50% ↓ | – | Start and maintain it: atorvastatin 40–80 mg; rosuvastatin 20-40 mg | – | +|| | |
| ACCF1, CABG, 2011 (27) | – | <100 mg/dL and >30% ↓; very high-risk: <70 mg/dL | – | Initiate it immediately | – | – | |
| ACCF2, SHID, 2012 (28) | – | – | – | Recommend moderate or high dose** | BAS and NC‡‡ | ||
| ACCF3, STEMI, 2013 (29) | + | – | – | Initiate or continue | – | – | |
| AHA1, secondary prevention, 2011 (30) | – | <100 mg/dL and >30% ↓; very high-risk: <70 mg/dL |
<130 mg/dL (TG ≥200 mg/dL); ery high-risk: <100 mg/dL (TG ≥200 mg/dL) |
Recommend** | BAS and NC, ezetimibe, FAD for TG >500 mg/dL‡‡; NC or FAD or fish oil; O3FA¶¶ |
||
| AHA2, NSTE-ACS, 2014 (31) | + | – | – | Initiate or continue | – | – | |
| NHFA/CSANZ1, 2016 (32) | – | – | – | Initiate and continue** | – | – | |
| JCS1&, CABG, 2011 (33) | – | – | – | Recommend** | – | ||
| JCS2&, ACS, 2011 (34) | – | – | – | Recommend for hyper-LDL-C and average LDL-C levels | High-purity EPA for high LDL-C, FAD for high TG or HDL-C | ||
+, requiring for fasting blood; 0: fasting blood is not necessary; *, most of the lipid lowering targets established by cardiovascular risk stratification; †, suggestion that have been discussed and concluded in tables but were not considered as officially graded recommendation; #, fasting lipid profile is not necessary unless the patients with HTG >4.5 mmol/L (<400 mg/dL); ‡, LDL-C needs fasting blood sample, non-HDL-C doesn’t need that; &, guidelines developed by JCS published in English are digest version; §, very high-risk: <1.8 mmol/L (70 mg/dL) or at least 50% reduction if the baseline is 1.8–3.5 mmol/L (70–135 mg/dL); ¶, approximately ≥50% reduction in LDL-C from baseline for high-intensity statin and 30% to <50% for moderate-intensity statin; **, guidelines that with or without emphasis on using the highest dose to achieve the targets, and without recommending specific intensity or drugs, merely recommend statins use for patients are in the absence of contradiction or adverse reaction or intolerance to statins; ††, use a low dose of atorvastatin if any one of the following apply: potential drug interactions; high risk of adverse effects; patients’ preference; ##, statins principally recommended to reduce cardiovascular risk in all patients with type 2 or type 1 diabetes mellitus above the age of 40 years; ‡‡, recommended for statin complementation: patients with contraindications for, or intolerance to statins or if the goal is not reached despite treatment with maximally tolerated statin dose; §§, recommended for TG reduction, despite statin treatment; ¶¶, recommended for non-HDL-C reduction, despite statin treatment; ||, if LDL-C ≥1.8 mmol/L (≥70 mg/dL) despite a maximally tolerated statin dose who remain at high risk, further therapy to reduce LDL-C should be considered. BAS, bile acid sequestrants; CAI, cholesterol absorption inhibitors (ezetimibe); EPA, ethyl icosapentate acid; FA, fatty acid; FAD, fibric acid derivatives (gemfibrozil, fenofibrate, fenofibric acid); NC, niacin (nicotinic acid); HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; O3FA, Omega-3 fatty acids (icosapent ethyl, omega-3-acid ethyl esters); PCSK9, proprotein convertase subtilisin/kexin type 9; TG, triglyceride.