Highlights

• Low-density lipoprotein cholesterol (LDL-C) is a well-established causal factor for the development of atherosclerotic cardiovascular disease (ASCVD) that should be monitored in a timely manner and may be modified through both lifestyle and pharmacological interventions.
• The primary goals for LDL-C management are to achieve an acceptable level for the patient’s risk category and to maintain that over time.
• Lower LDL-C for longer is better to reduce ASCVD risk.
• Despite the existence of cholesterol guidelines, universal screening ages, risk assessment tools, and recommendations for LDL-C management based on risk, data show that LDL-C measurement and management in patients with ASCVD are not meeting guideline-directed objectives.

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD) remains the #1 cause of death in the United States and has been on the rise for more than a decade after more than 40 years of steady decline. Low-density lipoprotein cholesterol (LDL-C) is a well-established causal factor for the development of ASCVD that should be monitored in a timely manner and may be modified through both lifestyle and pharmacological interventions. Despite the existence of cholesterol guidelines, universal screening ages, risk assessment tools, and recommendations for LDL-C management based on risk, data show that LDL-C measurement and management in patients with ASCVD are not meeting guideline-directed objectives. Further, there is no single clinical guideline that presents LDL-C measurement frequency, risk assessment, management, and desirable LDL-C levels for adults based on risk.

Objective: This document aims to summarize the numerous guidelines and recommendations from leading professional organizations to help clinicians and patients improve evidence-based measurement and management of LDL-C.

Methods: Guidelines and updates from the American College of Cardiology, American Heart Association, National Lipid Association, and other relevant professional organizations were systematically reviewed. Key recommendations were synthesized and translated into a simplified, patient-centered message for clinical application.

Results: The synthesis revealed consistent recommendations across major guidelines emphasizing early identification of risk, aggressive lipid lowering in high-risk populations, and the use of shared decision-making to improve adherence. The resulting simplified message aligns with current evidence and is intended to support clinical teams in delivering consistent, guideline-directed care.

Conclusion: Integrating major cardiovascular and lipid management guidelines into a unified, simplified message may improve provider clarity and patient understanding. This approach supports team-based care, reduces variation in practice, and enhances the implementation of evidence-based strategies to reduce ASCVD. The primary goals for LDL-C management are to achieve an acceptable level for the patient’s risk category and to maintain that over time because lower for longer is better to reduce ASCVD risk.