2026 Dyslipidemia Guidelines: Earlier Screening and What's Coming Next

In the third part of his interview with Pharmacy Times, Joseph Saseen, PharmD, BCPS, BCACP, CLS, professor and associate dean for clinical affairs in the Department of Clinical Pharmacy at the University of Colorado Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences, tackled statin intolerance, pediatric hypercholesterolemia screening, and the broader implications of the 2026 American College of Cardiology/American Heart Association dyslipidemia guidelines for pharmacists navigating an increasingly complex treatment landscape.

On statin intolerance, Saseen distinguished between patients with genuine statin-attributed muscle symptoms and what he called "statin-defiant" patients, who are those who refuse therapy based on misinformation circulating on social media. For patients with true symptoms, he recommended trialing more than one statin, ruling out secondary causes, and considering combination approaches using nonstatin agents alongside low-dose statin therapy.

He highlighted the SAMSON 2 trial (NCT03390686), an n-of-1 crossover study of 60 patients, which found average muscle symptom scores of 16 out of 100 with atorvastatin (Lipitor; Viatris) vs 15 out of 100 with placebo, suggesting that a significant portion of reported statin adverse effects may be nocebo-driven. He also stressed a deliberate language shift in the guidelines, replacing "risk-benefit" discussions with "benefit-risk" framing to more accurately reflect the favorable therapeutic profile of statins.

On pediatric screening, Saseen emphasized that children with a first-degree relative with familial hypercholesterolemia should be screened early and that statins are approved for use in children as young as 7 years when indicated. He also noted that the risk calculator now starts at age 30—down from 40—and that the low-density lipoprotein (LDL) threshold prompting treatment consideration has effectively moved from 190 mg/dL to 160 mg/dL in many patient populations.

Saseen closed by flagging emerging agents not yet captured in the guidelines, including lerodalcibep-liga (Lerochol; LIB Therapeutics), a novel proprotein convertase subtilisin/kexin type 9 inhibitor, and plozasiran (Redemplo; Arrowhead Pharmaceuticals), an apolipoprotein C-III inhibitor for severe hypertriglyceridemia, as well as the recently published phase 3 VESALIUS-CV trial (NCT03872401), which supports aggressive LDL lowering to below 55 mg/dL in select high-risk primary prevention populations.