Viet Le, DMSc, PA-C, is a preventive cardiology PA at Intermountain Health and the former president of the Academy of Physician Associates in Cardiology.

ACC/AHA Dyslipidemia Guidelines Focus on PREVENT, Lp(a), With Viet Le, DMSc, PA-C

On March 13, 2026, the American College of Cardiology (ACC) and American Heart Association (AHA) released an updated clinical guideline for the management of 

, replacing the 2018 Guideline on the Management of Blood Cholesterol.

In addition to overhauling the process of evaluating and monitoring patients with dyslipidemia, this new document encourages a paradigm shift away from the Pooled Cohort Equations (PCE) to the AHA’s more modern and comprehensive PREVENT model. Additionally, the guidelines now cite lipoprotein(a) as a major marker of elevated LDL-C, and one that can be used as a cascade predictor across families.

“It’s a big change, going from the Pooled Cohort Equations to PREVENT,” Viet Le, DMSc, PA-C, associate professor of research and preventive cardiology PA at Intermountain Health and ACC editor in chief, told 

 in an exclusive interview. “You have to calculate the risk now using PREVENT, but you’re personalized with risk enhancers. Those are still there, and then ultimately you can reclassify with coronary calcium.”

Since 2018, the PCEs have been the cornerstone of lifetime risk prediction of severe hypercholesterolemia, starting at age 21. The earlier guidelines recommended their use in informing focused risk discussion, highlighting tobacco use, sedentary lifestyle, and poor diet. The inclusion of the PCEs marked a significant emphasis on clinician-patient risk discussion and shared decision making.

The updated guidelines encourage clinicians to instead make use of the AHA’s Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations for 10- and 30-year risk assessments to guide lipid-lowering therapy (LLT) in patients between ages 30 and 79. Unlike their predecessor, PREVENT included a lower limit to begin risk prediction as well as including a larger sample of US adults for validation. PREVENT ultimately produces far more accurate risk estimates compared to the PCEs, particularly for 

atherosclerotic cardiovascular disease (ASCVD)

Another new component of the guidelines is the enhanced focus on lipoprotein(a), or Lp(a). The 2026 updated version recommends that clinicians measure Lp(a) ≥1 time in all adults when assessing for ASCVD risk, establishing a new Class of Recommendation (COR) 1 suggestion.

“Lp(a) helps us to do what’s called cascade screening. If you get it in everyone, a universal screening, then you can identify families where it’s elevated and implement therapies so much sooner. And not just pharmacologic therapy, but optimizing lifestyle,” Le said. “So, we need to test universally, at least once in everyone, identify those with high alkyl A, and then use that for cascade screening out to siblings, to children, and to children of siblings, all of whom may have elevated Lp(a).”

Editors’ Note: Le reports disclosures with Janssen, Pfizer, Novartis, Idorsia, Amarin, and Lexicon.

Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online March 13, 2026. 

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25). 

Videos

Le discusses the AHA/ACC clinical guidelines for the management of dyslipidemia, highlighting PREVENT and a renewed focus on Lp(a).

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Dyslipidemia

Strategic Alliance Partnership

Long-term Safety, REMS Data, and Echo Monitoring for oHCM Therapies

Real-world experience with cardiac myosin inhibitors under Risk Evaluation and Mitigation Strategy (REMS) programs provides critical insight into the safety profile of these agents outside the controlled environment of clinical trials.

Matthew Martinez, MD, discusses a large, REMS-guided analysis of more than 6000 patients that informed his understanding of the incidence, severity, and reversibility of left ventricular ejection fraction (LVEF) decline. He now quotes patients an approximate risk of LVEF reduction on the order of 4% to 7%, while acknowledging the need for further refinement of risk prediction. The same data suggest that REMS infrastructure—though unfamiliar to many cardiologists—helps standardize monitoring and maintain appropriate safety margins in routine practice.

Mariko Harper, MD, notes that, despite the boxed warning and patient concern about heart failure, REMS registry data have shown a very low rate of clinically meaningful LVEF decline with heart failure hospitalization, approximately 0.5% among more than 11,000 patients over several years when drugs are used according to protocol. This allows her to reassure informed patients who present having read the label and online resources. Both clinicians question whether current monitoring schedules are more intensive than necessary, particularly early 4-week echocardiograms and routine 6

month follow-up imaging in clinically stable patients on long-standing doses. They observe that most clinically meaningful changes correlate with recognized triggers such as infection, new medications, or atrial fibrillation rather than occurring unpredictably in otherwise stable individuals.

In this segment, Martinez and Harper propose a more risk-adapted approach to imaging-based surveillance, emphasizing symptom-triggered assessment and targeted evaluation in higher-risk periods while potentially de-emphasizing rigid time-based echocardiography in stable patients. They also describe how patient-reported symptoms usually precede concerning echocardiographic findings, suggesting that well-structured clinical follow-up and patient education may be at least as important as frequent imaging. Their discussion highlights how REMS-generated data can both reinforce the value of structured safety programs and guide thoughtful simplification of monitoring protocols over time.

Martinez and Harper review real-world REMS data on cardiac myosin inhibitors, refine approaches to safety monitoring, and question how frequently echocardiography is truly needed in stable oHCM patients.

Video Series

Implementing Cardiac Myosin Inhibitors in oHCM: Workflow and Team-Based Care

Effective implementation of cardiac myosin inhibitor therapy for oHCM depends heavily on systems of care rather than on the prescribing physician alone. Mariko Harper, MD, describes a dedicated cardiac myosin inhibitor clinic in Washington State staffed by a cardiac pharmacist who functions in many ways like an advanced practice provider. This pharmacist leads initiation, titration, drug–drug interaction review, and REMS documentation, while nurse coordinators manage direct lines of communication, scheduling, and coordination of echocardiography. Advance scheduling of the first several echocardiograms at the time of therapy planning, with flexibility to adjust as needed, provides clarity for patients and staff.

Matthew Martinez, MD, highlights the role of telemedicine for interim visits, which allows efficient, geographically flexible follow-up and facilitates rapid response to clinical or imaging changes. He and Harper emphasize that experienced sonographers, nurses, advanced practice providers, and pharmacists must function as equal partners in a “team sport,” with explicit empowerment to escalate concerns such as suspected atrial fibrillation or unexpected gradient patterns. Over time, as volumes increase, team members train newer staff, transforming what initially feels like a challenging REMS-driven process into a predictable, streamlined workflow after the first several patients.

Martinez and Harper also offer granular practical advice, such as coordinating the actual start date of therapy with the timing of follow-up echocardiography and patient support. They encourage patients to contact the nurse coordinator as soon as the initial shipment is received so that day 1 dosing and subsequent imaging timelines can be aligned. Martinez often recommends initiating therapy on a Sunday evening to maximize weekday availability for early follow-up and to ensure that questions about tolerability arise during regular clinic hours. This segment provides a detailed operational blueprint for clinicians seeking to integrate cardiac myosin inhibitors into everyday oHCM practice while maintaining high safety and patient satisfaction standards.

Martinez and Harper outline practical workflows for initiating and titrating cardiac myosin inhibitors, emphasizing multidisciplinary team structure, telemedicine, and logistics around REMS and imaging.

Emily McDonald, MD, MSc, is an associate professor of medicine at McGill University.

Vancomycin Taper for Recurrent C. difficile Infection: What Clinicians Need to Know

Recurrent infection is widely regarded as one of the most frustrating and costly challenges in the management of 

 infection (CDI), which affects an estimated 450,000 patients annually in the United States and carries substantial morbidity and healthcare costs.

For many patients, the illness does not end after the first episode. According to the US Centers for Disease Control and Prevention, about 1 in 9 people who get CDI will get it again in the subsequent 2-8 weeks.

"It's very unpleasant, can be quite morbid for patients, and once you've had a C difficile infection, unfortunately, there's a risk that it can come back over and over again,” Emily McDonald, MD, MSc, an associate professor of medicine at McGill University, explained to 

. “You can imagine how that can be pretty traumatic for patients, difficult to manage, and costly to the healthcare system, so it remains a big problem.”

 explored a potential strategy to reduce these recurrences: using an initial vancomycin taper regimen after standard therapy. Results suggest a 4-week vancomycin pulse and taper regimen may offer a safe and accessible treatment option to delay or prevent early CDI recurrence.

McDonald and colleagues performed the parallel-design, double-blind clinical trial at 12 hospitals in Canada and enrolled adults with a first episode or first recurrence of CDI. For inclusion, patients were required to have clinical CDI with laboratory confirmation and to have improved by day 10 of treatment.

All patients received a 2-week pulse of vancomycin standardized at 125 mg orally 4 times a day at the time of recruitment and were then random;ly assigned to receive either vancomycin taper, 125 mg orally twice a day for 7 days and then 125 mg once a day for 7 days, or an equivalent schedule of placebo capsules.

The primary outcome was the posterior probability of superiority of the vancomycin pulse and taper regimen to prevent rCDI at day 56. A secondary outcome was recurrence at day 38. Binary outcomes were analyzed using a bayesian generalized linear model with minimally informative priors yielding log relative risk (RR) with 95% bayesian credible intervals (CrIs).

The trial was stopped early due to feasibility of recruitment. Among 265 participants (n = 135 in the intervention group; n = 130 in the control group), recurrence at day 56 occurred in 14.8% of the vancomycin pulse and taper group compared with 17.7% of the vancomycin pulse group (adjusted RR, 0.84; 95% CrI, 0.48-1.45; posterior probability of superiority, 73.8%).

Recurrence at day 38 occurred in 6.7% of the vancomycin pulse and taper group compared with 15.4% of the vancomycin pulse group (adjusted RR, 0.43; 95% CrI, 0.19-0.89; posterior probability of superiority, 99.0%).

McDonald noted that findings have important implications in a treatment landscape that increasingly includes fidaxomicin, a guideline-preferred therapy that has demonstrated lower recurrence rates than vancomycin in prior studies. However, fidaxomicin remains significantly more expensive and less accessible in many healthcare systems.

According to McDonald, the results suggest that if clinicians are already planning to use vancomycin, extending therapy with a taper may be a practical strategy to reduce early recurrence risk. However, whether the taper approach ultimately proves comparable to fidaxomicin over longer follow-up remains an open question.

“I think it depends on what you have available, what the patient can afford, and your healthcare system,” McDonald said. “If you're using vancomycin, I would use the taper. I think it's a reasonable option compared to fidaxomicin, but that's a hypothesis. We don't know the answer for day 56.”

Editors’ Note: McDonald reports relevant disclosures with Fond de Recherche Sante Quebec.

McDonald EG, Butler-Laporte G, Brophy JM, et al. Initial Vancomycin Taper for the Prevention of Recurrent 

 Infection: A Randomized Clinical Trial. 

 2026;9(2):e2560495. doi:10.1001/jamanetworkopen.2025.60495

US Centers for Disease Control and Prevention. After C. diff: Caring for Yourself and Others. December 13, 2024. Accessed March 16, 2026. 

https://www.cdc.gov/c-diff/after/index.html

McDonald discusses new trial data suggesting an initial vancomycin taper may reduce early recurrence of C difficile infection.

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, IBS and IBD, Crohn's disease, and more.

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C. difficile condition center page, resources on the topics of medical news and expert insight into Clostridium difficile can be found. Content includes articles, interviews, videos, podcasts, and breaking news on C. diff research, treatment, and drug development.

Vancomycin Taper Strategies to Prevent C Difficile Recurrence, With Emily McDonald, MD, MSc

Comprehensive oHCM Follow-up: Hub-and-Spoke Care and 4-Pillar Framework

As oHCM prevalence and recognition increase, the limited capacity of specialized centers necessitates collaborative care models. Mariko Harper, MD, advocates for a hub-and-spoke strategy in which HCM centers of excellence provide initial diagnosis, risk stratification, and treatment planning, then partner closely with community cardiologists who assume much of the ongoing imaging, rhythm monitoring, and general cardiovascular management. Virtual initial consultations allow for early education, efficient planning of on-site testing, and tailored delegation of which assessments should occur locally versus at the referral center. Patients typically value annual visits to the expert center for complex counseling, genetic and family screening updates, and information on emerging therapies and clinical trials.

Matthew Martinez, MD, introduces a four-pillar framework he uses to structure follow-up encounters. The first pillar is symptom assessment, with attention to new, progressive, or changing limitations, including patients who underreport symptoms because of uncertainty about next steps. The second pillar is arrhythmia surveillance, particularly atrial fibrillation and ventricular tachycardia, both for symptom control and sudden cardiac death risk stratification. The third pillar involves family-based care, focusing on genetic testing where appropriate, periodic imaging of first-degree relatives, and reassessment of family history as life circumstances evolve. The fourth pillar centers on lifestyle, encompassing exercise prescriptions, weight management, nutrition, and pregnancy planning when relevant.

Within this structure, Martinez and Harper discuss practical use of stress echocardiography to detect latent obstruction even in patients deemed nonobstructive for many years, as well as the growing role of natriuretic peptides such as NT-proBNP in flagging changes in hemodynamics or unveiling new processes such as diastolic dysfunction or concomitant amyloidosis. They describe MRI at 3- to 5-year intervals in many patients for fibrosis assessment and risk stratification, and yearly echocardiography in most individuals—more frequently when on titrated medical therapy. This segment illustrates how Martinez and Harper integrate advanced diagnostics, collaborative care, and structured clinical frameworks to deliver comprehensive, long-term management for patients and families affected by oHCM.

Martinez and Harper describe a hub-and-spoke model for HCM care, follow-up cadence, and a structured “4-pillar” framework for longitudinal management, including imaging, biomarkers, and family-based risk strategies.



This segment of Eichenfield's interview highlights long-term safety findings on roflumilast cream .05% for children 2 - 5 years old with atopic dermatitis.

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Long-Term Safety of Roflumilast Cream for Children, With Lawrence Eichenfield, MD

Abigail Brooks is an assistant managing editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

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New data show tegoprubart enabled insulin independence and strong glycemic control in adults with long-standing type 1 diabetes undergoing islet transplantation.

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Tegoprubart Enables Insulin Independence in Type 1 Diabetes Islet Transplant Study

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

Allergy experts weigh ruxolitinib, tapinarof, and roflumilast—new nonsteroidal creams that reshape atopic dermatitis care beyond steroids.

From First Flare to Treatment-Free Intervals: Prescribing Nonsteroidal Topicals for Atopic Dermatitis

Kathryn Berlacher, MD, MS, is the clinical & strategic director of cardiology at UPMC and the chair of ACC 2026.

This conference preview with Kathryn Berlacher, MD, MS, and Kristen Campbell, PharmD, highlights the top 6 trials to watch at ACC 2026.

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The HCPLive heart failure page is a resource for medical news and expert insights on HF. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for heart disease, reduced and preserved ejection fraction, and more.

Atherosclerotic Cardiovascular Disease

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Conference Preview: American College of Cardiology Scientific Sessions 2026, With Kathryn Berlacher, MD, MS, and Kristen Campbell, PharmD

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Experts unpack biologics, molecular know-how, and patient trust—plus key previews for the upcoming AAD Annual Meeting.

podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, and Heart Trials.

ABCs in Dermatology

Welcome to ABC’s in Dermatology, HCPLive’s newest dermatology podcast, hosted by a pair of the field’s leading minds in Lindsay Ackerman, MD, and Chris Bunick, MD, PhD.

Created by the same team behind The Medical Sisterhood and Skin of Color Savvy, ABCs in Dermatology is a monthly podcast designed to deliver candid conversations, clinical insight, and forward-looking perspectives from the voices shaping dermatology today.

Introducing ABCs in Dermatology, with Lindsay Ackerman, MD, and Chris Bunick, MD, PhD

Chelsie Derman is an associate editor for 

who covers psychiatry, sleep medicine, geriatrics, migraine, and allergy. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

Investigational RNA interference therapy targeting prekallikrein enters accelerated regulatory pathway as phase 2 trial evaluates long-acting prophylaxis for HAE.

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FDA Grants Fast Track Designation to BW-20805 siRNA Therapy for HAE

The FDA has set a PDUFA date of December 30, 2026.

FDA Accepts NDA for Bezuclastinib in Non-Advanced Systemic Mastocytosis

Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

Data from the ACCESS II trial, ACCESS extension study, and a body composition study provide an early look at efficacy and safety data of a new investigational oral GLP-1.

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Interim Results from ACCESS Program of Aleniglipron Shows Weight Loss Efficacy

This interview highlights key points regarding new data on roflumilast cream 0.05% in children aged 2 to 5 years with atopic dermatitis.

On New Roflumilast Cream Data for Atopic Dermatitis in Children, With Lawrence Eichenfield, MD

Linda Stein Gold, MD, is a dermatologist at Henry Ford Health. 

Psoriasis severity goes beyond BSA: IGA, DLQI and high-impact areas redefine “moderate,” guiding when to move from topicals to systemic therapy.

Latest News

ACC/AHA Dyslipidemia Guidelines Focus on PREVENT, Lp(a), With Viet Le, DMSc, PA-C

Long-term Safety, REMS Data, and Echo Monitoring for oHCM Therapies

Implementing Cardiac Myosin Inhibitors in oHCM: Workflow and Team-Based Care

Vancomycin Taper Strategies to Prevent C Difficile Recurrence, With Emily McDonald, MD, MSc

Comprehensive oHCM Follow-up: Hub-and-Spoke Care and 4-Pillar Framework