| Secondary prevention |
| Stable ASCVD without comorbidities† | ≥ 50% LDL-C reduction and/or LDL-C < 100 mg per dL (2.59 mmol per L) | Ezetimibe (Zetia) | PCSK9 inhibitor |
| ASCVD with comorbidities† | ≥ 50% LDL-C reduction and/or LDL-C < 70 mg per dL (1.81 mmol per L) and/or non–HDL-C < 100 mg per dL (2.59 mmol per L) for patients with diabetes mellitus | Ezetimibe | PCSK9 inhibitor |
| ASCVD and baseline LDL-C ≥ 190 mg per dL (4.92 mmol per L) not due to secondary causes‡ | ≥ 50% LDL-C reduction and/or LDL-C < 70 mg per dL | Ezetimibe; bile acid sequestrant (if triglycerides < 300 mg per dL [3.4 mmol per L]) | PCSK9 inhibitor; if still above goal, refer to a clinical lipidologist§ |
| Primary prevention |
| No ASCVD; baseline LDL-C ≥ 190 mg per dL not due to secondary causes‡; no risk factors or comorbidities† | ≥ 50% LDL-C reduction and/or LDL-C < 130 mg per dL (3.37 mmol per L) | Ezetimibe; bile acid sequestrant (if triglycerides < 300 mg per dL) | PCSK9 inhibitor; if still above goal, refer to a clinical lipidologist§ |
| No ASCVD; baseline LDL-C ≥ 190 mg per dL not due to secondary causes‡; risk factors or comorbidities are present† | ≥ 50% LDL-C reduction and/or LDL-C < 100 mg per dL | Ezetimibe; bile acid sequestrant (if triglycerides < 300 mg per dL) | PCSK9 inhibitor; if still above goal, refer to a clinical lipidologist§ |
| 40 to 75 years of age; no ASCVD; diabetes; baseline LDL-C 70 to 189 mg per dL|| (1.81 to 4.90 mmol per L) | ≥ 50% LDL-C reduction and/or LDL-C < 100 mg per dL and/or non–HDL-C < 130 mg per dL | Ezetimibe | Bile acid sequestrant (if triglycerides < 300 mg per dL) |
| 40 to 75 years of age; no ASCVD; no diabetes; baseline LDL-C 70 to 189 mg per dL; ASCVD risk ≥ 7.5% without high-risk markers¶ | 30% to < 50% LDL-C reduction and/or LDL-C < 100 mg per dL | Ezetimibe** | Bile acid sequestrant (if triglycerides < 300 mg per dL) |
| 40 to 75 years of age; no ASCVD; no diabetes; baseline LDL-C 70 to 189 mg per dL; ASCVD risk ≥ 7.5% with high-risk markers¶ | ≥ 50% LDL-C reduction and/or LDL-C < 100 mg per dL | Ezetimibe | Bile acid sequestrant (if triglycerides < 300 mg per dL) |
