THRESHOLD TO START TREATMENT | TREATMENT TARGET | |||
---|---|---|---|---|
RISK LEVEL AND GUIDELINE | PRIMARY | ALTERNATE | PRIMARY | ALTERNATE |
High | ||||
• CCS | Treat all patients | Treat all patients | LDL: < 2.0 mmol/L or decrease by ≥ 50% | Non-HDL: < 2.8 mmol/L or decrease by ≥ 50% TC/HDL ratio: < 4.0 Apo B: < 0.80 g/L |
• ATP III | LDL: ≥ 2.5 mmol/L; consider treating all | Non-HDL: ≥ 3.3 mmol/L; consider treating all | LDL: < 1.8–2.5 mmol/L | Non-HDL: < 2.6–3.3 mmol/L |
• European* | Clinical judgment | NA | LDL: <1.8 mmol/L or decrease by ≥ 50% | Non-HDL: < 2.6 mmol/L or decrease by ≥ 50% Apo B: < 80 mg/dL |
Moderate | ||||
• CCS | LDL: > 3.5 mmol/L | Non-HDL: > 4.3 mmol/L TC/HDL ratio: > 5 | LDL: <2.0 mmol/L or decrease by ≥ 50% | Non-HDL: < 2.8 mmol/L or decrease by ≥ 50% TC/HDL ratio: < 4.0 Apo B: < 0.80 g/L |
• ATP III | LDL: > 2.5–3.4 mmol/L | Non-HDL: > 3.3–4.2 mmol/L | LDL: < 3.4 mmol/L | Non-HDL: < 4.2 mmol/L |
• European* | Clinical judgment | NA | LDL: < 2.5 mmol/L | Non-HDL: < 3.3 mmol/L Apo B: < 100 mg/dL |
Low | ||||
• CCS | LDL: ≥ 5 mmol/L | Non-HDL: ≥ 5.8 mmol/L TC/HDL ratio: > 6 | LDL: decrease by ≥ 50% | Non-HDL: Decrease by ≥ 50% TC/HDL ratio < 4.0 |
• ATP III | LDL: ≥ 4.0–5.0 mmol/L | Non-HDL: ≥ 4.8–5.8 mmol/L | LDL: < 4.0 mmol/L | Non-HDL: < 4.8 mmol/L |
• European* | Clinical judgment | NA | LDL: < 3.0 mmol/L | Non-HDL: < 3.8 mmol/L |
Apo B—apolipoprotein B, ATP—Adult Treatment Panel, CCS—Canadian Cardiovascular Society, HDL—high-density lipoprotein, IDL—intermediate-density lipoprotein, LDL—low-density lipoprotein, NA—not applicable, TC—total cholesterol, TG—triglyceride, VLDL—very low–density lipoprotein.
↵* European guidelines are based on a different risk scoring system.
Data from Genest et al,6 Anderson et al,7 Grundy et al,28 and Reiner et al.29