Key Updates in the Management of Patients with Hyperlipidemia

Craig Beavers, PharmD, FACC, FAHA, FCCP, BCCP, BCPS-AQ Cardiology, CACP, discusses how maximally tolerated statin therapy often fails to achieve target low-density lipoprotein cholesterol levels in high-risk patients with atherosclerotic cardiovascular disease and share strategies for optimizing adherence, including when to switch therapies to improve patient outcomes.

Panelists discuss how cardiology practice has evolved toward more aggressive low-density lipoprotein cholesterol (LDL-C)–lowering strategies across specialties, with current guidelines generally recommending targets below 70 mg/dL for high-risk patients and even lower thresholds (below 55 mg/dL) for very high-risk individuals, though these targets require personalization based on age, comorbidities such as diabetes and hypertension, and other cardiovascular risk factors.

Panelists discuss how evolving clinical guidelines for intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapies have shaped personalized treatment approaches through risk stratification, with different targets for primary vs secondary prevention and consideration of genetic factors when determining appropriate statin intensity.

Panelists discuss how statin therapy for primary prevention requires careful consideration of cardiovascular risk factors against potential adverse effects such as myalgia and liver abnormalities, generally favoring treatment when the calculated 10-year atherosclerotic cardiovascular disease [ASCVD] risk exceeds 7.5% to10% and adjusting recommendations based on individual patient factors including age, comorbidities, and preferences.

Panelists discuss how the initiation of statin therapy requires careful consideration of contraindications and patient-specific factors, particularly in those with liver disease, renal impairment, or advanced age, while noting evolving treatment patterns toward more intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapies based on individualized risk assessment.