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General lnternal Medicine Dyslipidemia Diagnosis The USPSTF recommends universal lipid screening in adults aged 40 to 75 years to calculate risk for ASCVD using the AHA/ACC Pooled Cohort Equations. DOil'T BE TRICKED . Do not obtain lipoprotein(a), apolipoprotein B, or LDL particles in the evaluation of dyslipidemia. Prevention and Treatment All patients at increased cardiovascular risk should be counseled regarding therapeutic lifestyle changes, including dietary modification, regular physical activi[2, weight loss, and smoking cessation. The ACC/AHA and USPSTF have differing guidelines for the primary prevention of ASCVD. USPSTF does not provide recom- mendations for secondary prevention of ASCVD. The USPSTF recommends that adults use a low to moderate dose statin for the primary prevention of CVD events and mortality when all of the following criteria are met: . age 40 to 75 years o >1 CVD risk factors (e.g., dyslipidemia, diabetes, hypertension, smoking) . calculated 10 year risk of a cardiovascular event of >10% The ACC/AHA recommends initiating statin therapy to reduce risk of ASCVD events in: 1. patients with clinical ASCVD (see categories below), 2. patients with an LDL cholesterol level >190 mg/dl, 3. patients with diabetes mellitus who are aged 40 to 75 years with an LDL cholesterol level of 70 to 189 mg/dl and no clinical ASCVD, and 4. patients without clinical ASCVD or diabetes and an LDL cholesterol level of 70 to 189 mg/dl and estimated 10 year ASCVD risk of >7.5o1,. Patients with an LDL cholesterol level of >i90 mg/dl and those with an ST segment elevation myocardial infarction at age <50 years should be evaluated for familial hypercholesterolemia. Ezetimibe may be used for primary prevention of ASCVD in patients with an LDL cholesterol level 2190 mg/dl who do not achieve a 50'/. reduction and/or have an LDL cholesterol level >100 mg/dl while taking maximally tolerated statin therapy. Patients with ASCVD eligible for secondary prevention therapy include those with:

Ezetimibe may be used for primary prevention of ASCVD in patients with an LDL cholesterol level 2190 mg/dl who do not achieve a 50'/. reduction and/or have an LDL cholesterol level >100 mg/dl while taking maximally tolerated statin therapy. Patients with ASCVD eligible for secondary prevention therapy include those with: . acute coronary slmdrome r history of MI, stable or unstable angina, coronary or other arterial revascularization . stroke or TIA . PAD or abdominal aorlic aneurysm High-intensity statin therapy (either atorvastatin or rosuvastatin) should be initiated in patients aged (75 years with ASCVD to achieve a reduction in LDL cholesterol of 50% or greater. If high intensity statin therapy is not tolerated, moderate-intensity statin therapy should be initiated to achieve a reduction in LDL cholesterol of 30% 49'y.. Patients at very high risk may benefit from the addition of ezetimibe if the LDL target is not reached. Baseline laboratory studies and monitoring: . baseline fasting lipid panel and ALT level . monitor ALT and CK only if a patient develops symptoms of hepatic or muscle disease 131