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Early Statin Use in Prevention
- For primary prevention, start statins early in patients with elevated LDL, diabetes, or high 10-year ASCVD risk.
- Use coronary artery calcium scoring to refine risk when uncertain and guide statin initiation.
Importance of Lipoprotein(a) Testing
- Lipoprotein(a) is highly heritable and a strong causal risk factor for ASCVD and aortic stenosis.
- Measuring it helps identify high-risk patients even when LDL is low, guiding potential therapies.
Manage Elevated Lipoprotein(a)
- Measure lipoprotein(a) at least once, especially in those with personal or family ASCVD history.
- Use PCSK9 inhibitors to lower lipoprotein(a) by 20-25% when additional LDL lowering is needed.