Excerpt from the Japan Atherosclerosis Society (JAS) Guidelines
for Prevention of Atherosclerotic Cardiovascular Diseases 2022
Diagnostic Criteria for Dyslipidemia
LDL cholesterol
140 mg/dL or more
Hyper-LDL-cholesterolemia
120-139 mg/dL
Borderline hyper-LDL-cholesterolemia **
HDL cholesterol
Less than 40 mg/dL
Hypo-LDL-cholesterolemia
Triglyceride
150 mg/dL or more (fasting blood sampling *)
Hypertriglyceridemia
175 mg/dL or more (blood sampling at any time *)
Non-HDL cholesterol
170 mg/dL or more
Hyper-non-HDL-cholesterolemia
150-169 mg/dL
Borderline hyper-non-HDL-cholesterolemia **
* Basically, 10 hours or more of fasting shall be deemed "fasting". However,
intake of non-caloric fluids such as water or tea shall be permitted.
If unable to be confirmed as "fasting", it shall be deemed "at any time".
** If the screening shows borderline hyper-LDL-cholesterolemia or borderline hyper-non-HDL-cholesterolemia,
consider whether there are high-risk pathologies and consider the need for treatment.
LDL-C shall be calculated using the Friedewald formula (TC - HDL-C - TG/5)
(however, only for fasting blood sampling) or using the direct method.
If TG is 400 mg/dL or higher or blood is sampled at any time, use non-HDL-C (= TC - HDL-C)
or the direct LDL-C method. However, when using non-HDL-C for the screening,
risk should be evaluated keeping in mind that in the absence of hypertriglyceridemia,
the difference from LDL-C may be less than +30 mg/dL.
The TG reference range differs depending on fasting blood sampling or blood sampling at any time.
HDL-C alone is not subjected to drug intervention.
Flowchart for Setting Lipid Control Targets from the Viewpoint
of Arteriosclerotic Disease Prevention
Calculate based on the scores by the Hisayama Study (Figure 3-2).
* Stenosis in 50% or more of the intracranial or extracranial arteries,
or aortic arch atheroma (maximum thickening of 4 mm or more).
Note: If diagnosed with familial hypercholesterolemia and
familial type III hyperlipidemia, do not use this chart, and see Chapter 4
"Familial Hypercholesterolemia" and Chapter 5 "Primary Dyslipidemia", respectively.
Lipid Control Targets by the Risk Classification
Principle of the Treatment Policy
Control Classification
Lipid Control Target (mg/dL)
LDL-C
Non-HDL-C
TG
HDL-C
Primary Prevention
- To improve the lifestyle first, and then take the application
of drug therapy into consideration.
Low Risk
<160
<190
<150 (fasting) *** <175 (at any time)
≥40
Intermediate Risk
<140
<170
High Risk
<120
<150
<100 *
<130 *
Secondary Prevention
- To take drug treatment into consideration along with lifestyle improvement.
History of coronary artery disease or atherothrombotic cerebral infarction
(including other cerebral infarction with overt atheroma ****)
<100 <70 **
<130 <100 **
* It shall be taken into consideration in diabetes mellitus with PAD,
microangiopathy (retinopathy, nephropathy, neuropathy)
complications or smoking (see Section 5.2 of Chapter 3).
** It shall be taken into consideration when complicated by any of the following four pathologies:
"acute coronary syndrome", "familial hypercholesterolemia", "diabetes mellitus",
and "coronary artery disease and atherothrombotic cerebral infarction
(including other cerebral infarction with overt atheroma)".
While non-drug therapy is the basic means of achieving control targets in primary prevention,
drug treatment shall be taken into consideration for 180 mg/dL or more of LDL-C in any
of the control classification. The possibility of familial hypercholesterolemia shall also
be taken into consideration (see Chapter 4).
Achieve the LDL-C control target first, followed by the non-HDL-C target.
Even if the LDL-C control target is achieved, high non-HDL-C is often associated with hypertriglyceridemia,
of which control is important. Low HDL-C should be addressed basically by lifestyle improvement.
These values are only targets to be achieved. For primary prevention (low to intermediate risks),
an LDL-C reduction of 20-30% can also be a target.
*** Ten hours or more of fasting shall be deemed "fasting".
However, intake of non-caloric fluids such as water or tea shall be permitted.
If unable to be confirmed as "fasting", it shall be deemed "at any time".
**** Stenosis in 50% or more of the intracranial or extracranial arteries, or aortic arch atheroma
(maximum thickening of 4 mm or more).
- See Chapter 7 for elderly people.
Cited and Modified from the Japan Atherosclerosis Society (JAS) Guidelines
for Prevention of Atherosclerotic Cardiovascular Diseases 2022,
Edited by Japan Atherosclerosis Society, 2022
