The SCORE2 algorithm and the Framingham Risk Score estimate 10-year cardiovascular risk. According to the ACC/AHA 2019 guidelines adopted under Indian NCD programmes, which of the following correctly identifies when statin therapy is recommended even without clinical atherosclerotic cardiovascular disease (ASCVD)?
- A LDL-C > 100 mg/dL in any adult above 40 years
- B Total cholesterol > 200 mg/dL in any diabetic above 30 years
- C 10-year ASCVD risk ≥ 7.5% using pooled cohort equations in adults aged 40–75 years with LDL-C 70–189 mg/dL ✓
- D Triglycerides > 400 mg/dL regardless of other risk factors
Correct answer: C. 10-year ASCVD risk ≥ 7.5% using pooled cohort equations in adults aged 40–75 years with LDL-C 70–189 mg/dL
Explanation
ACC/AHA 2019 guidelines recommend initiating moderate-to-high intensity statin therapy for primary prevention in adults aged 40–75 years with LDL-C 70–189 mg/dL when the 10-year ASCVD risk (using Pooled Cohort Equations) is ≥ 7.5%. Risk-enhancing factors (family history, hs-CRP, coronary artery calcium score) further guide the decision. NPCDCS incorporates these thresholds in HWC NCD management protocols. A blanket LDL or cholesterol threshold alone is insufficient to trigger statin therapy in primary prevention without risk stratification.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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