Lipid Screening
Fasting lipid panel in adults 20+ years
All Pathways
Family MedicineManagement
Hyperlipidemia Screening & Statin Therapy (ACC/AHA 2018)
Hyperlipidemia Screening & Statin Therapy (ACC/AHA 2018): Lipid Screening → Clinical ASCVD Present? → Secondary Prevention → Follow-Up.
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Decision Clinical ASCVD Present?
History of MI, stroke, PAD, or coronary revascularization
03Action Secondary Prevention
High-intensity statin for all clinical ASCVD
- Atorvastatin 40-80mg or Rosuvastatin 20-40mg
- LDL goal <70 (very high risk <55)
- Add ezetimibe if not at goal
- Consider PCSK9i if LDL ≥70 on max therapy
04Action Follow-Up
Recheck lipids 4-12 weeks after starting/adjusting
- Assess LDL response and adherence
- Monitor for muscle symptoms
- Check LFTs if symptoms
- Annual lipid panel once stable
05Decision LDL-C Level
Classify by LDL-C
- ≥190 = Severe hypercholesterolemia
- 70-189 = Calculate 10-year risk
06Action LDL ≥190 mg/dL
High-intensity statin without risk calculation
- Atorvastatin 40-80mg or Rosuvastatin 20-40mg
- Screen for familial hypercholesterolemia
- Consider cascade screening family
- Refer to lipid specialist if refractory
- Path rejoins step 04Shared downstream outcome
07Decision Diabetes Present?
Ages 40-75 with DM
08Action Diabetes + Age 40-75
Moderate-intensity statin minimum
- Moderate: Atorvastatin 10-20mg, Rosuvastatin 5-10mg
- Consider high-intensity if multiple risk factors
- LDL goal <100 (or <70 if high risk)
- DM is ASCVD risk equivalent in guidelines
09Action Calculate 10-Year ASCVD Risk
Use PCE calculator (ages 40-75, LDL 70-189)
- pooledcohortequations.org
- Inputs: age, sex, race, total cholesterol, HDL, SBP, DM, smoking, BP treatment
- Risk <5% = Low, 5-7.5% = Borderline, 7.5-20% = Intermediate, ≥20% = High
10Outcome Risk <5%
Lifestyle modification, reassess 4-6 years
11Action Risk 5-7.5%
Risk discussion, consider enhancers
- Risk enhancers: family hx premature ASCVD, metabolic syndrome, CKD, inflammatory conditions, elevated Lp(a), ABI <0.9
- If enhancers present, favor statin therapy
- CAC score can guide if uncertain
- Path rejoins step 04Shared downstream outcome
12Action Risk 7.5-20%
Moderate-intensity statin if risk discussion favors
- Consider CAC scoring to refine risk
- CAC = 0 may defer statin (unless DM, family hx)
- CAC 1-99 favors statin
- CAC ≥100 strongly favors statin
- Path rejoins step 04Shared downstream outcome
13Action Risk ≥20%
High-intensity statin to reduce LDL ≥50%
- Atorvastatin 40-80mg or Rosuvastatin 20-40mg
- Goal: ≥50% LDL reduction
- Add ezetimibe if needed for LDL <70
- Risk discussion still important
- Path rejoins step 04Shared downstream outcome
- Path rejoins step 09Shared downstream outcome
Guideline Source
2018 ACC/AHA Guideline on the Management of Blood Cholesterol
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address familial hypercholesterolemia management
- Statin intolerance strategies simplified
- PCSK9 inhibitor criteria not detailed
- Does not address pediatric lipid management
- Triglyceride management not primary focus
Contraindicated Populations
pediatricpregnancy
Applicable Regions
USAUEUUK
AU: Australian guidelines use Framingham-based risk
UK: NICE uses QRISK3 for risk assessment
US: ACC/AHA 2018 guidelines with 10-year ASCVD risk calculator
Version 1Next review: 2028-01-01
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Hyperlipidemia Screening & Statin Therapy (ACC/AHA 2018)?
The Hyperlipidemia Screening & Statin Therapy (ACC/AHA 2018) is a management clinical algorithm for Family Medicine. It provides a structured decision tree to guide clinical decision-making, based on 2018 ACC/AHA Guideline on the Management of Blood Cholesterol.
What guideline is the Hyperlipidemia Screening & Statin Therapy (ACC/AHA 2018) based on?
This algorithm is based on 2018 ACC/AHA Guideline on the Management of Blood Cholesterol (DOI: 10.1016/j.jacc.2018.11.003).
What are the limitations of the Hyperlipidemia Screening & Statin Therapy (ACC/AHA 2018)?
Known limitations include: Does not address familial hypercholesterolemia management; Statin intolerance strategies simplified; PCSK9 inhibitor criteria not detailed; Does not address pediatric lipid management; Triglyceride management not primary focus. Individual patient factors may require deviation from these recommendations.
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