Dyslipidemia back in focus
Dyslipidemia back in focus
• New ESC/EAS focused update (2025) is influencing upcoming AHA/ACC guidelines expected in early 2026.
• Major advances since the last US update in 2019 support lower LDL-C targets in high-risk patients.
• Updated risk assessment tools: SCORE2/SCORE2-OP in Europe; AHA PREVENT in the US.
• Screening — when?
• Start at age 20 for routine lipid screening.
• Earlier only if high risk (strong family history, suspected familial hypercholesterolemia).
• Repeat every 4–6 years if low risk; more often if risk is present.
• Greater emphasis on risk enhancers, including:
• Lp(a) elevation
• CAC (coronary artery calcium score on CT) indicating subclinical atherosclerosis
• Chronic kidney disease (CKD)
• Pregnancy-related risk (history of preeclampsia, gestational hypertension or diabetes, premature menopause)
• Family history of premature ASCVD
• Evidence supports earlier and sustained LDL-C lowering, including initiation during ACS hospitalization.
• In patients with subclinical CAD, treatment targets often aim for LDL-C <55 mg/dL within a high-risk primary prevention framework; aspirin is not routinely recommended as primary prevention and should be considered only in selected patients with CAC ≥400 and low bleeding risk.
• Recognition that LDL-C alone may underestimate risk in metabolic syndrome.
• Bempedoic acid endorsed for select patients, particularly statin-intolerant individuals, with cost and safety considerations (uric acid/gout).
• Lp(a) testing recommended at least once in a lifetime for improved risk stratification.
Source: Medscape Medical News
Date: February 05, 2026
🔗 https://www.medscape.com/viewarticle/dyslipidemia-recent-research-prompts-new-guidance-2026a10003o7
