“ACC Updates Guidelines on Non-Statin Therapy in Patients with ASCVD” Sep 2017
” … includes the following changes since 2016:
For adults with clinical ASCVD who are taking statins for secondary prevention and have an LDL of 70–189 mg/dL, the threshold for a net risk-reduction benefit is still an LDL lowering of at least 50%, but clinicians may now consider an LDL of less than 70 mg/dL or a non-HDL level of less than 100 mg/dL for all patients, regardless of comorbidity.
For patients in this LDL range with comorbidities, clinicians may consider prescribing either ezetimibe or a proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitor. Factors favoring choice of ezetimibe include the need for less than 25% additional LDL lowering and the cost of generic ezetimibe. A PCSK9 inhibitor may be preferred if the patient needs greater LDL lowering.
Among the factors that may help identify ASCVD patients at higher risk for recurrent events: age 65 and older, previous myocardial infarction or nonhemorrhagic stroke, or daily cigarette smoking.”