| 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 |
Malaysia (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 |
Philippines (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) |
Thailand (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 |
Vietnam (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 |