Highlights

• Individualized risk assessment and personalized treatment are essential for optimal cardiovascular risk reduction.
• Cumulative data from clinical trials, genetic studies, registries, and real-world experience support the importance of sustained LDL-C lowering for cardiovascular event reduction.
• Achieving LDL-C goals and measuring LDL-C to assure maintenance is an essential quality metric for improvement of population health.

Abstract

Atherosclerotic heart disease is a leading cause of morbidity and mortality with the magnitude of ASCVD event reduction being proportional to the degree of Low Density Lipoprotein Cholesterol (LDL-C) lowering. The 2026 ACC/AHA/Multidisciplinary Guideline on the Management of Dyslipidemia highlights the need to achieve LDL-C levels that are “lower for longer” with treatment targeted to individual Atherosclerotic Cardiovascular Disease (ASCVD) risk. Current risk estimators, biomarkers and imaging tools have allowed for the improved discrimination of ASCVD risk to select those who benefit most and guide the intensity of treatment. With the combination of optimal lifestyle therapy and an armamentarium of lipid lowering agents, achieving optimal levels is attainable and essential to cardiovascular health. Referrals to lipid specialists should be considered for complex care to increase access to advanced therapeutics and managed complex cases. Toward that goal, lipid panel testing should be done regularly in adults to evaluate ASCVD risk and to monitor for effectiveness and adherence to LDL-C lowering treatment. The following manuscript is intended to serve as a “simplified” guide the management of LDL-C in clinical practice.