First-line lipid-modifying drug therapy

Clinical trials demonstrate a continuous relationship between the extent of lowering of atherogenic lipoproteins (low-density lipoprotein cholesterol [LDL-C] and non–high-density lipoprotein cholesterol [non–HDL-C]) and a reduction in the incidence of cardiovascular events. The efficacy of statins in reducing morbidity and mortality is well established for both primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD).

Use statins as first-line lipid-modifying therapy to reduce ASCVD risk in all patients with established ASCVD or at high ASCVD risk.

A more aggressive approach to initial treatment (eg starting a high-potency statin at a high dose) is recommended for secondary prevention of cardiovascular events, and is reasonable for primary prevention in some patients with high ASCVD risk.

Target lipid concentrations depend on the patient’s ASCVD risk estimate. If lipid targets are not met despite at least 6 weeks of the maximum tolerated dose of a statin, consider additional therapy to meet LDL-C targets or additional therapy to meet triglyceride targets.

Identify and manage causes of secondary dyslipidaemia. Lipid-modifying therapy is often required despite management of a secondary cause.