|Recommendations||NHLBI Grade||NHLBI Evidence Statements||ACC/AHA COR||ACC/AHA LOE|
|Monitoring Statin Therapy|
|Optimizing Statin Therapy|
|Insufficient Response to Statin Therapy|
|E (Expert Opinion)||—||IIa||B (46–48,78,106,107)|
|E (Expert Opinion)||—||IIb||C (9,14,108–110)|
|E (Expert Opinion)||—||IIa||B (88,101,111–116)|
ACC indicates American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; COR, Class of Recommendation; LDL-C, low-density lipoprotein cholesterol; LOE, Level of Evidence; NHLBI, National Heart, Lung, and Blood Institute; RCTs, randomized controlled trials; and —, not applicable.
↵∗ Several RCTs found that low-intensity and low-moderate–intensity statin therapy reduced ASCVD events. In addition, the Cholesterol Treatment Trialists meta-analyses found that each 39-mg/dL reduction in LDL-C reduces ASCVD risk by 22%. Therefore, the Panel considered that submaximal statin therapy should be used to reduce ASCVD risk in those unable to tolerate moderate- or high-intensity statin therapy.
↵† In those already on a statin, in whom baseline LDL-C is unknown, an LDL-C level <100 mg/dL was observed in most individuals receiving high-intensity statin therapy.
↵‡ Clinical ASCVD includes acute coronary syndromes, or a history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin.