Putting the Guidelines into Practice: Building a State-of-the-Art Lipid and Cardiometabolic Clinic-Key Implementation Highlights from the 2026 Guideline on the Management of Dyslipidemia

Key Implementation Highlights from the 2026 Guideline on the Management of Dyslipidemia

Video Transcription

Video Summary

The speaker highlights lipid guideline updates most relevant to CKM (cardiovascular-kidney-metabolic) clinics. Key measurement changes include using non-fasting lipid panels for screening, but fasting panels when triglycerides are >400 mg/dL. The guidelines recommend replacing the Friedewald equation with more accurate LDL-C estimators (e.g., Martin-Hopkins, NIH) and routinely reporting non–HDL-C; advanced particle testing is discouraged. ApoB measurement is newly recommended for patients with ASCVD, CKM/type 2 diabetes, or elevated triglycerides to detect residual risk after LDL-C/non–HDL-C goals are met. Absolute lipid targets return, with stricter goals for higher-risk and “very high risk” patients (LDL-C and ApoB <55 mg/dL). Lipoprotein(a) should be measured at least once, especially in CKD. Lifestyle therapy (Mediterranean/DASH diet, activity, weight management) remains foundational, with more intensive dietary restrictions as triglycerides rise and dietitian referral for TG 150–999 and >1000. Risk assessment uses PREVENT-ASCVD, risk enhancers, reproductive markers, and coronary calcium scoring. New therapy pathways add ezetimibe, PCSK9 inhibitors, bempedoic acid, inclisiran, and icosapent ethyl when indicated, with CKD stage ≥3 treated as high risk.

Keywords

CKM lipid guideline updates

non-fasting lipid panel and triglycerides >400 mg/dL fasting

LDL-C estimation Martin-Hopkins NIH and non–HDL-C reporting

ApoB and lipoprotein(a) measurement for residual risk

ASCVD risk assessment PREVENT-ASCVD and therapies PCSK9 inclisiran bempedoic acid icosapent ethyl