Version July 2025
ABI: arterial brachial index; apoB: apolipoprotein B; ASCVD: atherosclerotic cardiovascular disease; CAC: coronary artery calcium score; CVD: cardiovascular disease; DM: diabetes mellitus; HDL: high-density lipoprotein; HIV: human immunodeficiency virus; hsCRP: high-sensitivity C-reactive protein; HTN: hypertension; LDL: low-density lipoprotein; Lp(a): lipoprotein a; RA: rheumatoid arthritis.
* This includes triglycerides and total, HDL, and LDL cholesterol levels.
¶ For individuals ages 30 to 59, use a validated ASCVD risk calculator that quantifies 30-year ASCVD risk. Refer to UpToDate content on ASCVD risk assessment in primary prevention for validated risk calculators to estimate 10- and 30-year ASCVD risks. Patients with type 2 DM should ideally undergo risk estimation with a calculator that includes diabetes and diabetes-relevant risk enhancers. For details on primary prevention strategies in adults with diabetes, refer to relevant UpToDate content on general medical care in nonpregnant adults with diabetes mellitus.
Δ Among patients at low or borderline 10-year risk (<10%), those at high 30-year risk (≥39%) are at greater risk of atherosclerotic disease progression than those with low 30-year risk (<39%) and may experience greater absolute risk reduction from statin therapy.
◊ Clinicians should individualize risk discussions for these patients. Benefit from statin therapy in this group is generally small. Risk discussions should include lifestyle interventions to reduce ASCVD risk and weigh the relative risks and benefits of statin therapy. For details, refer to UpToDate content for discussion of the management of individuals with elevated LDL-cholesterol for primary prevention.
§ Clinicians should individualize risk discussions for these patients. Many patients in this group may benefit from statin therapy. Risk discussions should include lifestyle interventions to reduce ASCVD risk and weigh the relative risks and benefits of statin therapy. Patients in whom uncertainty persists regarding statin treatment may benefit from additional risk stratification with CAC scoring and, for those ages 39 to 59, calculation of 30-year ASCVD risk. For details on the use of CAC scores, refer to UpToDate content.
¥ Patients in this group benefit from statin therapy. For adults at intermediate to high ASCVD risk, discuss the benefits and risks of treatment with low-dose aspirin for ASCVD risk reduction. Refer to UpToDate content on aspirin in the primary prevention of cardiovascular disease and cancer for details.
