11 A Toolkit for Healthcare Professionals individuals with dyslipidemias, including high blood cholesterol, hypertriglyceridemia and elevated lipoprotein(a).9 Considerations for LLT • The guideline recommends using PREVENT-ASCVD 10-year and 30-year risk estimates to guide lipid-lowering therapy (LLT) decisions in adults aged 30 to 79 years with LDL-C 70 to 189 mg/dL and no history of ASCVD. Moderate-intensity statin therapy is reasonable for those with borderline 10-year ASCVD risk (3% to <5%) and for selected adults aged 30 to 59 years with low 10-year risk (<3%) but LDL-C 160 to 189 mg/dL or 30-year ASCVD risk ≥10%; at least moderate-intensity statin therapy is recommended for intermediate 10-year risk (5% to <10%), high-intensity statin therapy for high 10-year risk (≥10%) and maximally tolerated statin therapy for individuals with LDL-C ≥190 mg/dL regardless of estimated risk.9 • Use ASCVD risk and the degree of LDL-C lowering achieved to guide LLT. Adults at borderline or intermediate risk should achieve a 30% to 49% LDL-C reduction, with greater LDL-C lowering at the higher end of risk. Adults at high risk should achieve at least a 50% LDL-C reduction, with additional LDL-C lowering as needed to reach guideline-recommended goals. If LDL-C goals are not achieved on maximally tolerated statin therapy in adults who are at high risk, adding ezetimibe is reasonable and, when appropriate, a PCSK9 inhibitor or bempedoic acid may be considered.9 • LDL-lowering is recommended for primary prevention in adults aged 40 to 75 with diabetes, chronic kidney disease stage 3 or 4 or human immunodeficiency virus, regardless of LDL-C level. After age 75 years, LDL-C-lowering pharmacotherapy can be considered alongside lifestyle interventions to reduce ASCVD risk9 • In patients with persistently elevated triglycerides (TG), statin therapy remains the foundation as an adjunct to lifestyle intervention to reduce ASCVD risk. Treatment to prevent pancreatitis may also include TG-lowering therapies, especially in individuals with TG levels ≥1000 mg/dL (11.3 mmol/L).9 Blood Pressure Management The 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines integrates the PREVENT equations to refine treatment thresholds.10 The guideline recommends using the PREVENT-CVD outcome-specific equation to estimate 10-year risk of total CVD to inform management decisions for Stage 1 hypertension (systolic blood pressure [SBP] 130-139 mm Hg or diastolic blood pressure [DBP] 80-89 mm Hg) among adults without known CVD, diabetes or CKD. Considerations for Antihypertensive Therapy • Initiating medication therapy to lower blood pressure in addition to lifestyle interventions is recommended for all adults with average blood pressure ≥140/90 mm Hg and/or for selected adults with average blood pressure ≥130/80 mm Hg who have clinical CVD, previous stroke, diabetes, chronic kidney disease or increased 10-year predicted cardiovascular risk of ≥7.5% as defined by the PREVENT-CVD. • For adults with average blood pressure ≥130/80 mm Hg and at a lower 10-year cardiovascular disease risk defined by PREVENT-CVD of <7.5%, initiating medication therapy to lower blood pressure is recommended if average blood pressure remains ≥130/80 mm Hg after an initial three- to six-month trial of lifestyle modification. • For adults with Stage 2 hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), antihypertensive therapy is recommended regardless of estimated PREVENT-CVD risk. Heart Failure (HF) Management For management decisions about HF prevention therapies, the PREVENT-HF equations may help inform clinician-patient discussions. For further guidance on management of heart failure beyond the CKM framework, clinicians should continue to follow current recommendations for HF prevention from The 2026 AHA/ ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-KidneyMetabolic Syndrome: A Report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. • Cardiac biomarker assessment (natriuretic peptides and/or high-sensitivity troponin) can be considered in those with CKM syndrome who are at increased 10-year predicted HF risk (PREVENT-HF ≥5%)
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