Table 1. Statin Eligibility Criteria According to 5 Major ASCVD Primary Prevention Guidelines.
| Criteria | NICE | USPSTF | CCS | ESC/EAS | ACC/AHA |
|---|---|---|---|---|---|
| Lipid-based | |||||
| Cholesterol level | LDL-C >190mg/dL or TC >290 mg/dL | NA | LDL-C ≥193 mg/dL | LDL-C >232 mg/dL or TC >309 mg/dL | LDL-C ≥190 mg/dL |
| Risk-based | |||||
| Age range, y | 40-75 | 40-75 | 40-75 | 40-65 | 40-7 |
| Eligibility | QRISK2 ≥ 10% predicted 10-y risk of any ASCVD or nondialysis–dependent CKD | PCE ≥10% predicted 10-y risk of any ASCV plus ≥1 CVD risk factora | FRS ≥20% predicted 10-y risk of any ASCVD or age 40-75 y; FRS≥10% to <20% predicted 10-y risk of any ASCVD; LDL-C ≥135 mg/dLb or diabetes or CKD (age ≥50 y) and eGFR level <60 mL/min/1.73m2 | LDL-C level ≥155 mg/dL; SCORE 5% to <10% predicted 10-y risk of fatal ASCVD or age 40-65 y; LDL-C ≥97 mg/dL; SCORE ≥10% predicted 10-y risk of fatal ASCVD or diabetes; or nondialysis–dependent CKD and eGFR level <60 mL/min/1.73m2 | PCE ≥7.5% predicted 10-y risk of any ASCVD; LDL-C 70-189 mg/dL or diabetes (plus LDL-C level ≥70 mg/dL); risk-enhancersc: family history of ASCVD, persistently elevated LDL-C levels ≥160 mg/dL, CKD, metabolic syndrome, persistently elevated triglycerides ≥175 mg/dL, hs-CRP levels ≥2.0 mg/dL; Lp(a) levels >50mg/dL, apoB levels ≥130mg/dL, and ankle-brachial index <0.9 |
Abbreviations: ACC, American College of Cardiology; ASCVD, atherosclerotic cardiovascular disease; AHA, American Heart Association; apoB, apolipoprotein B; CCS, Canadian Cardiovascular Society; CKD, chronic kidney disease; CVD, cardiovascular disease; ESC, European Society of Cardiology; EAS, European Atherosclerosis Society; eGFR, estimated glomerular filtration rate; FRS, Framingham Risk Score; LDL-C, low-density lipoprotein cholesterol; Hs-CRP, high-sensitivity C-reactive protein; Lp(a), Lipoprotein(a); NICE, National Institute for Health and Care Excellence; PCE, pooled cohorts equations; TC, total cholesterol; USPSTF, US Preventive Services Task Force.
SI conversion factor: To convert apoB to grams per liter, multiply by 0.01; cholesterol levels to millimoles per liter, multiply by 0.0259; Lp(a) to micromoles per liter, multiply by 0.0357; triglycerides to millimoles per liter, multiply by 0.0113.
USPSTF CVD risk factors include dyslipidemia (LDL-C levels >130 mg/dL or high-density lipoprotein cholesterol levels <40 mg/dL), diabetes, hypertension, and smoking.
Or non–high-density lipoprotein cholesterol levels at least 166 mg/dL or men 50 years and older and women 60 years and older with LDL-C levels less than 135 mg/dL but with a CVD risk factor.
Risk-enhancing factors to help guide class IIb statin allocation in the ACC/AHA guidelines. Chronic inflammatory conditions, history of premature menopause, and preeclampsia are also ACC/AHA defined risk enhancers, but information on these variables were not available for this study.