- Internists can take advantage of this synopsis of the 2018 multisociety cholesterol clinical practice guideline, with a diagram to guide decision-making in primary prevention.
Why this matters
- Heart-healthy living should ideally begin in childhood.
- Risk discussion between the clinician and patient is “still strongly recommended” in the primary prevention setting.
- Patients can be triaged into 4 risk categories: low, borderline, intermediate, high.
- For intermediate risk: have a focused discussion before starting statins, pinpoint factors enhancing risk, consider coronary artery calcium testing.
- Focus on percentage reduction in low-density lipoprotein cholesterol (e.g., by at least 50%), long-term monitoring of treatment efficacy, with nonfasting lipid measures allowed.
- For secondary prevention, with very high risk, patients might need to add nonstatins (e.g., ezetimibe or proprotein convertase subtilisin/kexin type 9) to statins.
- Flow diagram for primary prevention is available here .
- A synopsis of guidelines specifically for the internal medicine audience.