Joseph Saseen, PharmD, explains the 2026 dyslipidemia guidelines' push for universal lipoprotein A screening, clarifies when apolipoprotein B testing adds value, and outlines how new FDA-approved therapies fit into the updated lipid-lowering treatment algorithm.
In the second 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, addressed the 2026 American College of Cardiology/American Heart Association dyslipidemia
On biomarker testing, Saseen drew a clear distinction between apolipoprotein B and lipoprotein A, or Lp(a). Apolipoprotein B remains an optional confirmatory measure, appropriate for patients with atherosclerotic cardiovascular disease, kidney disease, or metabolic conditions who have already achieved their low-density lipoprotein (LDL) and non–high-density lipoprotein goals, to confirm that atherogenic lipoproteins are sufficiently treated. Lp(a), by contrast, has been elevated to a universal screening recommendation.
Saseen noted that the 2026 guidelines align with the National Lipid Association's 2024 position that every adult should have their Lp(a) measured at least once, with earlier testing considered for individuals with a first-degree relative known to have elevated levels. Although no FDA-approved therapies specifically targeting Lp(a) exist, an elevated Lp(a) result should prompt clinicians to be more aggressive with overall lipid-lowering and cardiovascular risk-reduction strategies.
On nonstatin therapies, Saseen outlined how bempedoic acid (Nexletol; Esperion Therapeutics), inclisiran (Leqvio; Novartis), and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are now clearly positioned in the guidelines as add-on therapies for patients who cannot achieve LDL goals on statin therapy alone, whether due to inadequate response or statin intolerance. He noted that PCSK9 inhibitors and inclisiran offer more robust LDL lowering, whereas bempedoic acid provides approximately 20% LDL reduction, similar to ezetimibe (Zetia; Merck & Co), and may serve as a first-line option in statin-intolerant patients. Saseen also flagged newer agents approved after the guideline's data cutoff, including a second-generation PCSK9 inhibitor and a new triglyceride-lowering drug, as additional tools that will likely be incorporated into future updates.
