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REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #10 2025

LDL cholesterol management simplified in adults-Lower for longer is better: Dyslipidaemia

Guidance from the National Lipid Association.
Jackson EJ, et al. J Clin Lipidol. 2025 Jun 18;000:1-8.

Given the rising burden of morbidity and mortality from CVD, along with an expanding range of effective therapies and evolving
treatment targets, increasingly detailed and complex guidelines continue to emerge. Despite these comprehensive guidelines, real-
world data show that LDL-C measurement and management often fail to meet directed objectives. In response to both this treatment
gap and the challenge of interpreting these extensive guidelines, the authors of this paper developed a simplified, unified framework
for clinicians to streamline LDL-C management for non-lipid specialists.

Included in this review are recommendations issued by leading professional organisations, like the American College of Cardiology
(ACC), American Heart Association (AHA), and National Lipid Association (NLA). By systematically reviewing and synthesising these
guidelines, the authors aim to provide clear and concise reference guidance for primary care providers and other clinicians who
manage lipids. The fundamental, patient-centred message derived from this synthesis is that the primary goal of LDL-C management
is to achieve and maintain an acceptable level for the patient’s risk category over time, emphasising that “lower for longer is better” to
reduce ASCVD risk.

The synthesis of guidelines revealed consistent recommendations across major organisations, emphasising early risk identification
and aggressive lipid lowering in high-risk populations, coupled with shared decision-making to improve adherence. Routine LDL-C
measurement in all adults is encouraged, at least every five years. All children should have their lipid panel screened between the
ages of nine to 11 and again between 17 to 21.

Recommended lipid screening intervals based on age, CV risk, and treatment regimen

The scientific results confirm that ASCVD events are reduced proportionately to the degree of LDL-C lowering, the level achieved,
and the length of time over which a lower level is maintained. Evidence supports the safety of achieving very low LDL-C levels,
with numerous studies finding progressively lower ASCVD risk down to levels below 30 mg/dL, with no evidence of harm to other
metabolic pathways. For healthy adults, optimal LDL-C is <100 mg/dL, while high-risk patients, such as those with diabetes,
familial hypercholesterolaemia, or an estimated 10-year ASCVD risk of greater than 20%, should aim for <70 mg/dL. Very high-risk
individuals, including those with recent ACS or multiple major risk factors, should target <55 mg/dL.

Treatment intensity is guided by ASCVD risk, starting with statin therapy as the cornerstone. Statins are categorised by their LDL-
C-lowering potency, with low-intensity regimens reducing LDL-C by <30%, moderate-intensity by 30%–49%, and high-intensity by
≥50%. When additional LDL-C lowering is required, non-statin therapies such as ezetimibe, bempedoic acid, or PCSK9 inhibitors
can be added, providing incremental LDL-C reductions ranging from 14% to 60% and proven reductions in MACEs. For very high-
risk patients, combination therapy with ezetimibe or a PCSK9 inhibitor may be initiated early to achieve rapid and durable LDL-C

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