This document summarizes the 2013 ACC-AHA guidelines for cholesterol treatment. It outlines an algorithm for screening and statin treatment based on cardiovascular risk factors and LDL cholesterol levels. For those between 40-75 years old, it recommends either moderate or high-intensity statin therapy depending on calculated 10-year risk of atherosclerotic cardiovascular disease. High-intensity statin therapy is recommended for those with clinical atherosclerotic CVD or LDL cholesterol over 190 mg/dl. The guidelines also provide definitions of moderate and high-intensity statin regimens and a link to the risk calculator. Limitations noted are that risk factors like family history are not considered and those under 21 or over 75 without disease are not addressed.

1. New Cholesterol
Treatment Guideline2013
ACC-AHA Task
Force Practice Guidelines
November 12, 2013,

2. Algorithm
Patients >21 yr. of age without heart failure (NYHA class II, III, or IV) or end-stage renal disease (undergoing haemodialysis) Screen for cardiovascular risk
factors, measure LDL cholesterol
Clinical
Clinical
atherosclerotic
atherosclerotic
CVD CVD
High-intensity
statin therapy
DM I or II & age of 40–75 yr
and LDL 70–189 mg/dl
Calculate 10-yr risk of
atherosclerotic CVD
If risk <7.5%, moderateintensity
statin therapy If risk .7.5%, highintensity statin therapy
No DM & age of 40–
75 yr & LDL 70–189
mg/dl
Calculate 10-yr risk
of atherosclerotic
CVD
LDL ≥ 190 mg/dl
High-intensity statin
therapy
If risk .7.5%, moderate-tohighintensity statin therapy

3. Intensity of statin therapy
High-intensity statin therapy
Moderate-intensity statin therapy
Daily dose lowers LDL
cholesterol level by
approximately ≥50% on
average
Recommended:
atorvastatin, 40 to 80 mg
rosuvastatin, 20 to 40 mg
 Daily dose lowers LDL cholesterol level
by approximately 30 to <50% on
average
 Recommended: atorvastatin, 10 to 20
mg; rosuvastatin, 5 to 10 mg;
simvastatin,20 to 40 mg; pravastatin,
40 to 80 mg; lovastatin, 40 mg;
extended-release fluvastatin,80 mg;
fluvastatin, 40 mg twice a day;
pitavastatin, 2 to 4 mg

4. 10 Year risk score calculator
• http://my.americanheart.org/cvriskcalculator or at
http://www.cardiosource.org/

5. Advantage
Only Statins
Only LDL-Cholesterol

6. Limitation: No Rx for
Below 21 Years
Above 75 yrs. without atheromatous
disease
Other risk factor like family Hx of
Premature atheromatous disease have not
been taken into consideration