ClearRounds Health · Cardiology · Quick Reference

Lipid Management / HLD / ASCVD Prevention

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LDL goals, statin intensity, ezetimibe, PCSK9, inclisiran/bempedoic acid considerations, diabetes/ASCVD risk, CAC use, and clinic escalation.

Last reviewed

July 17, 2026

2026 ACC/AHA Dyslipidemia/Cholesterol Guideline (PREVENT-ASCVD; "earlier and lower for longer")
Local formulary & prior-authorization pathways

Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.

Clinically reviewed by the site owner. Still verify against the sources above and local protocol before clinical use.

LDL-C is causal in atherosclerosis — "earlier and lower for longer" reduces events.
Estimate risk with PREVENT-ASCVD (ages 30–79), which replaces the Pooled Cohort Equations.

Fasting or nonfasting lipid panel (nonfasting is fine for screening).
Measure Lp(a) once in adulthood; ApoB in selected patients (diabetes, high triglycerides, CKM, established CVD).
CAC scoring to refine borderline–intermediate risk (men >40 / women >45).

Setting	LDL-C target
Primary prevention (borderline/intermediate risk)	<100 mg/dL
High-risk primary prevention	<70 mg/dL
Established ASCVD	<70 mg/dL
Very-high-risk ASCVD	<55 mg/dL (intensify if 55–69)

Lifestyle foundation: diet, activity, weight, smoking cessation.
High-intensity statin (atorvastatin 40–80, rosuvastatin 20–40) for ASCVD/high risk; moderate-intensity for intermediate risk.
If not at goal, add nonstatins in sequence: ezetimibe and/or bempedoic acid, then a PCSK9 monoclonal antibody (or inclisiran).
Triglycerides >500 mg/dL: treat to prevent pancreatitis (fibrate; icosapent ethyl in selected patients).

LDL ≥190, early ASCVD, or strong family history → suspect familial hypercholesterolemia: treat aggressively and screen relatives.
Statin intolerance: don’t abandon therapy — rechallenge, lower dose, or alternate agent.
Markedly elevated Lp(a): intensify other risk factors.

Recheck lipids 4–12 weeks after starting/changing therapy, then every 3–12 months.
Check LFTs/CK only if symptomatic; document the percent LDL reduction.

A CAC score of 0 means lower MACE risk — use it to refine the risk estimate, not by itself to defer or de-escalate indicated therapy.
Lp(a) is a once-in-a-lifetime test — order it.
Earlier treatment matters: cumulative LDL exposure drives risk.

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