Target LDL
แนวทางเวชปฏิบัติการบำบัดภาวะไขมันผิดปกติในเลือดเพื่อป้องกันโรคหัวใจและหลอดเลือด พ.ศ. 2567
2024 RCPT Clinical Practice Guideline on Management of Dyslipidemia for Atherosclerotic Cardiovascular Disease Prevention
Secondary prevention
Primary prevention
CAD
++, 1, A
ACS
Target LDL-c < 55 mg/dL AND
≥ 50% reduction
Target LDL-c =
++, 1, A
Age > 75 years or inability to tolerate high-dose, high-intensity statin
High-dose and high-intensity statin as soon as possible
Moderate-intensity statin
+, 1, B
Goal not achieved in 4-6 weeks
+ Ezetimibe
+, 1, A
Goal not achieved in 4-6 weeks
Consider PCSK9 inhibitor
CCS
++, 1, A
Target LDL-c < 70 mg/dL AND
≥ 50% reduction
Target LDL-c =
++, 1, A
Statin adjusted dose to achieve goal
+, 1, B
Goal not achieved in 4-6 weeks
+ Ezetimibe
+, 1, A
Goal not achieved in 4-6 weeks
Consider PCSK9 inhibitor
Stroke/TIA (non-cardioembolic stroke)
LDL-c < 100 mg/dL
+, IIa, C
Moderate to High-intensity statin
No target LDL-c
LDL-c ≥ 100 mg/dL
without atherosclerotic disease
(intracranial a., carotid a.)
++, 1, B
High-intensity statin
Target LDL-c < 100 mg/dL
* Very high risk: stroke plus another major ASCVD or stroke plus multiple high-risk conditions
LDL-c ≥ 70 mg/dL
with atherosclerotic disease
(intracranial a., carotid a.)
++, 1, B
High-intensity statin
+/- ezetimibe
Target LDL-c < 70 mg/dL
++, 1, B
Very high risk*
Non reach LDL-c target
(LDL-c ≥ 70 mg/dL)
++, 1, B
Consider PCSK9 inhibitor
Target LDL-c < 70 mg/dL
Diabetes
DM <40 years
0-1 risk factor
1-2 risk factors
3 - 6 months after TLC
LDL-c ≥ 100 mg/dL
+-, IIb, C
+, IIa, C
Statin + TLC
target LDL-c < 100 mg/dL
TLC: Therapeutic lifestyle change
TG: Triglyceride
DM ≥ 40 years
0-1 risk factor
LDL-c < 190 mg/dL
++, 1, A
LDL-c ≥ 190 mg/dL
++, 1, A
Statin + TLC
Target LDL-c <100 mg/dL and ≥ 30%reduction
Target LDL-c =
Statin + TLC
Target LDL-c <100 mg/dL and ≥ 50%reduction
Target LDL-c =
1-2 risk factors
++, 1, A
Statin + TLC
Target LDL-c <100 mg/dL and ≥50%reduction
Target LDL-c =
TG 150-499 mg/dL
+, IIa, B
TLC + glycemic control
Statin + pure EPA
Chronic kidney disease
CKD stage 2a - 5ND
(eGFR < 60 mL/min/1.73 m2, not on dialysis),
Age ≥ 50 Years, LDL ≥ 100 mg/dL
++, 1, A
Low to moderate intensity statin
or
Statin/ezetimibe
Target LDL < 100 mg/dL
or ≥ 30% reduction
Target LDL-c =
CKD stage 5D
(on dialysis)
-, 3, B
Statin or statin/ezetimibe
should not been initiated
CKD KT
(on dialysis)
II, IIa, B
Statin
Familial hypercholesterolemia (FH)
++, 1, A
High-intensity statin
Target LDL-c < 70 mg/dL
and ≥ 50% reduction
Target LDL-c =
Ezetimibe
Goal not achieved
+, 1, A
+, IIa, A
Goal not achieved
PCSK9-inhibitor
Adult ≥ 21 years
LDL-c ≥ 190 mg/dL
Moderate-intensity statin
Target LDL-c < 100 mg/dL
and ≥ 50% reduction
Target LDL-c =
High intensity statin
Goal not achieved
++, 1, A
Adult ≥ 35 years
LDL-c < 190 mg/dL
10-year risk ≥ 10%
Low to Moderate-intensity statin
Target LDL-c < 100 mg/dL
and ≥ 30% reduction
Target LDL-c =
High intensity statin
Goal not achieved
++, 1, A
10-year risk < 10%
Subclinical atherosclerosis*
Risk enhancing factors**
Low to Moderate-intensity statin
Target LDL-c < 100 mg/dL
and ≥ 30% reduction
Target LDL-c =
Subclinical atherosclerosis*
coronary calcium score > 100 Agatston units
ankle-brachial index < 0.9
Risk enhancing factors**
psoriasis, rheumatoid arthritis, HIV infection)
+/-, IIb, B
Goal not achieved
High intensity statin
References
แนวทางเวชปฏิบัติการบำบัดภาวะไขมันผิดปกติในเลือดเพื่อป้องกันโรคหัวใจและหลอดเลือด พ.ศ. 2567
(2024 RCPT Clinical Practice Guideline on Management of Dyslipidemia for Atherosclerotic Cardiovascular Disease Prevention)
Link: http://www.rcpt.org/index.php/news/2012-09-24-09-26-20/1014--2567.html