Lipid Management in Moderate-Risk Patients

Risk Stratification

The American College of Cardiology recommends calculating the 10-year cardiovascular disease risk using validated risk calculators to guide treatment decisions in patients with moderate-risk profiles 1, 2
A patient's LDL-C level of 117 mg/dL is below the 130 mg/dL threshold that typically triggers pharmacotherapy in moderate-risk patients, according to the American College of Cardiology 1, 2
The American Heart Association suggests that elevated triglycerides, such as 331 mg/dL, place patients at increased cardiovascular risk 3

The American College of Cardiology recommends reducing saturated fat to <7% of total calories and cholesterol intake to <200 mg/day to target both LDL-C and triglycerides 3, 2, 5
The American Heart Association suggests eliminating trans fatty acids to <1% of total energy intake 5, 4
The National Lipid Association recommends adding plant sterols/stanols 2 g/day and soluble fiber >10 g/day for an additional 5-10% LDL-C reduction 5
The American College of Cardiology recommends consuming fish twice weekly or considering 850-1000 mg EPA/DHA supplementation to address hypertriglyceridemia 2
The American Heart Association suggests emphasizing fruits, vegetables, whole grains, low-fat dairy, legumes, and lean proteins in the diet 3, 2

The American College of Cardiology recommends considering starting a statin if, after 3-6 months of intensive lifestyle changes, LDL-C remains ≥130 mg/dL in a moderate-risk patient 1, 2
The American College of Cardiology suggests that statin therapy should be initiated simultaneously with lifestyle changes to achieve LDL-C <100 mg/dL if the 10-year cardiovascular risk is calculated to be >20% 1, 2
The American Diabetes Association recommends that patients with diabetes or other CHD risk equivalents should be started on statin therapy, as they are automatically placed in the high-risk category requiring statin therapy 1

The American College of Cardiology recommends targeting at least 30-40% LDL-C reduction from baseline when initiating statin therapy 1, 5
The National Lipid Association suggests monitoring for muscle symptoms, liver enzymes, and blood glucose when initiating statin therapy 5
The American Heart Association recommends not immediately starting statins in a patient with LDL-C <130 mg/dL without first calculating cardiovascular risk and attempting lifestyle modifications 1, 2