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Table 2 Local guidelines for management of plasma lipid disorders

From: Prevalence of plasma lipid disorders with an emphasis on LDL cholesterol in selected countries in the Asia-Pacific region

  CV risk scoring system used Goal Recommended treatments for
Primary prevention Patients with diabetes Secondary prevention
Indonesia (Indonesian Heart Association Guidelines on Management of Dyslipidemia 2017) [41] • Stratification of CV risks as low, medium, high, or very high
• SCORE scale is most commonly used
• Jakarta Cardiovascular score (Modified Framingham Risk) has also been introduced based on local data [46]
• Very high risk: LDL-C < 70 mg/dL and/or 50% reduction if baseline 70–135 mg/dL
• High risk: LDL-C < 100 mg/dL or 50% reduction if baseline 100–200 mg/dL
• Moderate risk LDL-C < 115 mg/dL
• Lifestyle intervention includes diet, physical activity, BMI reduction, and smoking cessation
• Statins may be initiated with lifestyle intervention for those with high risk and very high risk
• Similar strategy with very high risk and high risk categories
• For those with ASCVD or target organ damage, LDL-C goal < 70 mg/dL; for those without ASCVD or target organ damage, LDL-C < 100 mg/dL
• If target LDL-C cannot be reached with highest tolerated doses of statin, non-statin therapy may be considered
• Statins for all patients unless statin intolerant
• Additional non-statin therapy with ezetimibe or PCSK9 inhibitors if LDL-C goals not achieved with highest tolerated dose of statins
(Management of Dyslipidemia 2017) [42]
• CV risk scores (Framingham General CVD) used • Low and intermediate CV risk: < 3.0 mmol/L (116 mg/dL)
• High CV risk: ≤2.6 mmol/L (100 mg/dL) or a reduction of > 50% from baseline
• Very high CV risk: < 1.8 mmol/L (70 mg/dL) or a reduction of > 50% from baseline
• TLC recommended
Statins for those with high and very high CV risk as well as those with low and moderate CV risk after TLC
• Statins for all patients with diabetes > 40 years
• High-intensity statins for patients with diabetes and CVD
• High-intensity statins for all patients with CHD or ACS and prior to PCI and CABG
(2015 Clinical Practice Guidelines for the Management of Dyslipidemia in the
Philippines) [43]
• Risk factor counting to identify patients in need of statins • < 130 mg/dL (or a 30% reduction) for those at lower risk
• < 70 mg/dL (or > 30% reduction) for those with established ASCVD
• Statins for non-diabetic patients aged ≥45 years with LDL-C ≥ 130 mg/dL and ≥ 2 risk factors without atherosclerotic CVD and for diabetic individuals without atherosclerotic CVD Regardless of age of CV risk, guidelines recommend initiation of moderate- intensity statin therapy • High-intensity statin (based on LDL-C reduction)
(2016 RCPT Clinical Practice Guideline on Pharmacologic Therapy of Dyslipidemia for Atherosclerotic Cardiovascular Disease Prevention) [44]
• CV risk score used based on Thai patient population (Thai CV Risk Score) • < 130 mg/dL (or a 30% reduction) for those with 10-year risk ≥10%
• < 100 mg/dL for primary prevention in DM, CKD, or familial hypercholesterolemia
• < 70 mg/dL (or a 50% reduction) for clinical ASCVD
• Statins for patients with LDL-C ≥ 190 mg/dL, familial hypercholesterolemia, 10-year risk ≥10% • Statins for patients:
 - DM ≥ 40 years
 - DM < 40 years + 2 CV risk factors + LDL-C ≥ 100 mg/dL (moderate intensity statins)
 - DM < 40 years with 0 or 1 CV risk factor + LDL-C ≥ 100 mg/dl (low to moderate intensity statins)
• Statins (moderate to high intensity depending on atherosclerotic CVD)
• Non-statin if LDL-C target not reached in 6 months
(Recommendations on Diagnosis and Treatment of Lipid Disorders 2015)
• SCORE scale (low risk) used
• Stratification of CV risk as low, medium, high, or very high
ESC recommendations for goals
Primary < 100 mg/dL
Secondary < 70 mg/dL
Statins for patients with LDL-C ≥ 190 mg/dL • Statins for patients aged 40–75 with diabetes and LDL-C between 70 and 189 mg/dL
• High-intensity statins used for most patients with diabetes
• Statins for patients with atherosclerosis, acute coronary syndrome, history of MI, stable/unstable angina
• LDL < 70 mg/dL
  1. Abbreviations: ACS acute coronary syndrome; ASCVD atherosclerotic cardiovascular disease; CABG coronary artery bypass grafting; CHD coronary heart disease; CKD chronic kidney disease; CV cardiovascular; CVD cardiovascular disease; DM diabetes mellitus; eGFR estimated glomerular filtration rate; HbA1c glycated hemoglobin; LDL-C low-density lipoprotein cholesterol; MI myocardial infarction; PCI percutaneous coronary intervention; TLC therapeutic lifestyle changes