A lipidologist outlines how PREVENT, coronary calcium scoring, and restored LDL-C targets guide personalized lipid therapy and where pharmacists fit in.
In this episode of The Tell-Tale Heart podcast, recorded live at the National Lipid Association’s (NLA) 2026 Fall Lipid Update in Orlando, Florida, Craig Beavers, PharmD, FACC, FAHA, FCCP, BCCP, BCPS-AQ Cardiology, CACP, partners with the NLA’s Lipid Insights podcast to welcome Michael J. Wilkinson, MD, FACC, FNLA, associate professor of medicine and director of the advanced lipid treatment program at UC San Diego Health. The two experts discussed how the 2026 American College of Cardiology/American Heart Association multisociety dyslipidemia guideline is reshaping lipid management and focused on risk assessment, lipoprotein(a) [Lp(a)], and the expanding lipid-lowering toolkit.
Wilkinson identified 2 of the guideline's biggest changes: the adoption of the PREVENT-ASCVD equations for risk stratification and the return of treatment targets for low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein (HDL) cholesterol, and, in many cases, apolipoprotein B. For younger patients, whose 10-year risk estimates are often low, he said framing conversations around 30-year or lifetime risk is more meaningful. He added that UC San Diego Health has already begun tracking LDL-C in secondary prevention as an internal quality measure.
This was a collaboration with the National Lipid Association's Lipid Insights podcast. You can listen to more Lipid Insights on Apple Podcasts or Spotify.
Michael J. Wilkinson, MD, FACC, FNLA, is an associate professor of medicine and director of the advanced lipid treatment program at UC San Diego Health. You can find him on Linkedin.
He also addressed the recommendation that every adult have Lp(a) measured once. An estimated 1 in 5 people worldwide have Lp(a) at or above 125 nmol/L, yet fewer than 1% of the US population is tested, with barriers including test access, result interpretation, and confusion over units. Wilkinson stressed that elevated Lp(a) is actionable now because it calls for more intensive management of LDL-C, blood pressure, glucose, and other modifiable risk factors.
Discussing the topline Lp(a)HORIZON (NCT04023552) results, in which pelacarsen did not meet its primary endpoint, Wilkinson cautioned that full data are pending and that other Lp(a)-targeted agents in phase 3 trials differ in mechanism, dosing, and study population, including high-risk primary prevention.
He also discussed weighing inflammatory conditions and coronary artery calcium scores in shared decision-making, choosing between oral and injectable proprotein convertase subtilisin kexin type 9 PCSK9 inhibitors, and the role of pharmacists in medication optimization, monitoring, dose adjustments, and repeat lipid testing.
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