|Risk Category||LDL-C Goal||Initiate TLC||Consider Drug Therapy⁎⁎|
|High risk:CHD⁎or CHD risk equivalents†(10-year risk >20%)||<100 mg/dL (optional goal: <70 mg/dL)∥||≥100 mg/dL#||≥100 mg/dL††(<100 mg/dL: consider drug options)⁎⁎|
|Moderately high risk:2+ risk factors‡(10-year risk 10% to 20%)§§||<130 mg/dL¶||≥130 mg/dL#||≥130 mg/dL (100–129 mg/dL; consider drug options)‡‡|
|Moderate risk:2+ risk factors‡(10-year risk <10%)§§||<130 mg/dL||≥130 mg/dL||≥160 mg/dL|
|Lower risk:0–1 risk factor§||<160 mg/dL||≥160 mg/dL||≥190 mg/dL (160–189 mg/dL: LDL-lowering drug optional)|
↵⁎ CHD includes history of myocardial infarction, unstable angina, stable angina, coronary artery procedures (angioplasty or bypass surgery), or evidence of clinically significant myocardial ischemia.
↵† CHD risk equivalents include clinical manifestations of noncoronary forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and carotid artery disease [transient ischemic attacks or stroke of carotid origin or >50% obstruction of a carotid artery]), diabetes, and 2+ risk factors with 10-year risk for hard CHD >20%.
↵‡ Risk factors include cigarette smoking, hypertension (BP ≥140/90 mm Hg or on antihypertensive medication), low HDL cholesterol (<40 mg/dL), family history of premature CHD (CHD in male first-degree relative <55 years of age; CHD in female first-degree relative <65 years of age), and age (men ≥45 years; women ≥55 years).
↵§ Almost all people with zero or 1 risk factor have a 10-year risk <10%, and 10-year risk assessment in people with zero or 1 risk factor is thus not necessary.
↵∥ Very high risk favors the optional LDL-C goal of <70 mg/dL, and in patients with high triglycerides, non-HDL-C <100 mg/dL.
↵¶ Optional LDL-C goal <100 mg/dL.
↵# Any person at high risk or moderately high risk who has lifestyle-related risk factors (eg, obesity, physical inactivity, elevated triglyceride, low HDL-C, or metabolic syndrome) is a candidate for therapeutic lifestyle changes to modify these risk factors regardless of LDL-C level.
↵⁎⁎ When LDL-lowering drug therapy is employed, it is advised that intensity of therapy be sufficient to achieve at least a 30% to 40% reduction in LDL-C levels.
↵†† If baseline LDL-C is <100 mg/dL, institution of an LDL-lowering drug is a therapeutic option on the basis of available clinical trial results. If a high-risk person has high triglycerides or low HDL-C, combining a fibrate or nicotinic acid with an LDL-lowering drug can be considered.
↵‡‡ For moderately high-risk persons, when LDL-C level is 100 to 129 mg/dL, at baseline or on lifestyle therapy, initiation of an LDL-lowering drug to achieve an LDL-C level <100 mg/dL is a therapeutic option on the basis of available clinical trial results.