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The current ACC/AHA Guideline on Cholesterol Management calls for calculating ASCVD 10-year risk with the Pooled Cohort Risk Calculator as an initial step in determining appropriate statin intensity, where a moderate intensity statin would normally be recommended if the risk is <7.5% or high intensity statin if the risk is >7.5%. The ACC/AHA Cardiovascular Risk Assessment guidelines also consider a positive family history, CAC score of >75% or >300, ankle brachial index <0.9, or hs-CRP >2 mg/L to help better inform the treatment decision; for instance, in deciding between a high and low intensity statin in the case of diabetes. Moreover, we might also consider a diabetic of longer duration (e.g., 10 years or greater) or with a higher HbA1c to be at higher risk and while not technically in the ACC/AHA guidelines, could also be used as risk stratifiers in deciding on appropriate statin intensity.

Keywords: Ankle Brachial Index, Cardiovascular Diseases, Cholesterol, Diabetes Mellitus, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Risk Assessment, Risk Factors, Metabolic Syndrome

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