Updated ACC/AHA Dyslipidemia Guidelines Incorporate LDL-C Goals, Lp(a) Focus, With Deepak Bhatt, MD, MPH

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.

Among some of the most significant changes, the new guidelines encourage clinicians to enhance their focus on lipoprotein(a), or Lp(a). This updated version suggests clinicians measure Lp(a) ≥1 time in all adults when addressing 

atherosclerotic cardiovascular disease (ASCVD) 

risk. This suggestion is now a Class of Recommendation (COR) 1 suggestion.

“I’ve been a believer in measuring Lp(a) for a long time, way before it was in vogue. I used to test it in patients who came in with premature MI,” Deepak Bhatt, MD, MPH, director of Mount Sinai Fuster Heart Hospital and the Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai, told 

 in an exclusive interview. “I think one can debate the exact level of evidence – we’re all eagerly awaiting, probably later this year, the first randomized clinical trials looking at Lp(a) drugs. If those trials are positive, that validates that specific therapeutics lowering Lp(a) as clinically useful.”

Additionally, the 2026 guidelines have shifted from percent reduction of LDL-C back to specific, targeted goals. The previous 2018 version introduced the use of percent LDL-C reductions as a method of monitoring lipid levels and guiding lipid-lowering therapy (LLT). This method was widely considered vague, as these percentages were inherently subjective between patients. Goals, however, establish concrete targets. Although percentage risk reduction in LDL-C was retained as a priority for individuals, LDL-C and non-HDL-C treatment goals are reclaiming their spot as the backbone of LLT guidance.

Specific goals are determined by PREVENT risk tier, with those at borderline risk – between 3 and <5% - having a goal LDL-C of <100 mg/dL and a goal non-HDL-C of <130 mg/dL. Those at intermediate risk – 5 to <10% - have a goal LDL-C of <100 mg/dL, while those at high risk - ≥10% - have a goal LDL-C of <70 mg/dL and a non-HDL-C goal of <100 mg/dL.

Secondary prevention also incorporates LDL-C goals based on these new guidelines; those with high risk, defined as ≥2 major ASCVD events or 1 event and ≥2 high-risk features have a goal LDL-C of <55 mg/dL and non-HDL-C <85 mg/dL. These patients should also receive ezetimibe in addition to maximum tolerated statin. However, those not at very high risk have an LDL-C goal of <70 mg/dL and non-HDL-C of <100 mg/dL.

“I do like the fact that targets are clearly back in the guidelines,” Bhatt said. “That was a real backward step some years ago when the guidelines eliminated targets for LDL. It’s a good illustration of the fact that the guidelines are not always sacrosanct. If you look at different times and places, guidelines have made mistakes. They don’t replace good clinical judgment or individualized patient care.”

Editors’ Note: Bhatt reports disclosures with GSK, Merck, Cereno Scientific, Angiowave, Boehringer Ingelheim, Novo Nordisk, and others.

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. 

Livingston R. AHA/ACC Dyslipidemia Guidelines Reinstate LDL-C Goals, With Viet Le, DMSc, PA-C. 

. March 17, 2026. Accessed March 25, 2026. 

https://www.hcplive.com/view/aha-acc-dyslipidemia-guidelines-reinstate-ldl-c-goals-with-viet-le-dmsc-pa-c

Videos

Bhatt shares his thoughts on the recently released dyslipidemia guidelines, highlighting the return of goal-based LDL-C therapy and Lp(a) receiving a COR 1 suggestion.

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Dyslipidemia

Atherosclerotic Cardiovascular Disease

Strategic Alliance Partnership

Allergist-immunologist at Yale New Haven Hospital

The Case for Delabeling NNAALs in Obstetric Care, With Chang Su, MD

Non-narcotic analgesics allergy labels (NNAAL) significantly elevated rates of eclampsia (aRR, 1.5; 95% CI, 1.06–2.12), preterm birth (aRR, 1.21; 95% CI, 1.14–1.28), NICU admission (aRR, 1.17; 95% CI, 1.10–1.25), and neonatal withdrawal syndrome (aRR, 1.51; 95% CI, 1.24–1.84) among labeled mothers across 2,244,210 California singleton livebirths — point toward a clear intervention target: the family planning stage, before pregnancy makes formal drug challenge testing contraindicated.

American Academy of Allergy, Asthma & Immunology (AAAAI)

 2026 Annual Meeting held in Philadelphia, Pennsylvania, from February 27 to March 2, Chang Su, MD, allergist-immunologist at Yale New Haven Hospital outlined why timing matters enormously for NNAAL de-labeling efforts. Evaluating a prior ibuprofen reaction, for example, ideally requires a provocation challenge — which is contraindicated during pregnancy. Waiting until a patient is already pregnant to initiate drug allergy evaluation therefore forecloses the most definitive diagnostic pathway. Su's preferred model is pre-conception referral, integrated into routine family planning screening by OB-GYN and cardiology colleagues, so that allergy status is clarified before it becomes clinically urgent. She described active efforts to work NSAID allergy screening into standard documentation templates and electronic health record workflows used by APPs and physicians in OB practices at her institution — a structural intervention designed to normalize proactive referral rather than relying on reactive, crisis-driven evaluation.

Su also used the final portion of the conversation to reframe how the field should think about drug allergy labels more broadly. NNAALs affect approximately 2% of the population — rarer than beta-lactam labels, which appear in roughly 10% of charts, and therefore harder to study at scale. The study does not overturn existing paradigms around allergy labeling, Su acknowledged, but it extends the known harms of inappropriate labels from beta-lactams into the NSAID class, and makes it easier to extrapolate that other inaccurate allergy labels likely carry similar outcome consequences. Her broader call to action was cultural as much as clinical: rather than entering a blank medication allergy into the chart, clinicians should document the specific reaction type, severity, and any confirmed tolerability thresholds — information that allows downstream providers to make nuanced decisions rather than defaulting to broad avoidance. As Su put it, allergy labels are not a single entity, and the field is increasingly recognizing that indiscriminate labeling carries real repercussions, particularly when it walls patients off from first-line therapies tied to the best outcomes.

Su has no relevant disclosures to report.

1. Su C, Baer R, Otani I, Schatz M, Chambers C. The relationship between maternal non-narcotic analgesics allergy labels and maternal and fetal outcomes: results from a large, administrative cohort. Presented at: AAAAI 2026 Annual Meeting, February 27-March 2, Philadelphia, Pennsylvania. Abstract #L24

2. Non-Narcotic Analgesics Allergy Labels Linked to Adverse Maternal and Fetal Outcomes. News release. AAAAI. February 26, 2026. 

https://www.aaaai.org/about/news/news/2026/narcotic

Su emphasized how care should be shifted to reflect known impacts of NNAALs on obstetric care.

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Andres Gelrud, MD, is a gastroenterologist at Baptist Health Miami Cancer Institute, part of Baptist Health South Florida

Why Exocrine Pancreatic Insufficiency Is Frequently Underdiagnosed, With Andres Gelrud, MD

 remains underdiagnosed and undertreated, but improving awareness could help address persistent gaps in clinical care.

Many clinicians and patients remain unaware of EPI’s strong association with diabetes and other pancreatic diseases, contributing to delays in diagnosis.

“Exocrine pancreatic insufficiency is a condition that is caused by multiple reasons, but mainly inadequate production of pancreatic enzymes,” said Andres Gelrud, MD, a gastroenterologist at Baptist Health Miami Cancer Institute, part of Baptist Health South Florida, in an interview with HCPLive. “It’s also defined as inadequate delivery or activity of the pancreatic enzymes needed for normal digestion, and here we’re talking about lipase, protease, and amylase.”

EPI results from inadequate secretion and/or delivery of pancreatic enzymes and bicarbonate into the duodenum, impairing normal digestion. Disruption of acinar cell function, reduced enzyme output, or ductal obstruction limits the availability of key digestive enzymes, including lipase, protease, and amylase. Lipase activity is typically affected earliest, leading to impaired fat digestion before carbohydrate and protein malabsorption. This progressive enzyme deficiency underlies the characteristic features of maldigestion and nutrient malabsorption seen in EPI.

The likelihood of developing EPI is increased in high-risk populations. Among patients with chronic pancreatitis, approximately 60%–90% develop EPI. Prevalence is also high in cystic fibrosis (~85%) and pancreatic cancer (66%–92%), with additional risk observed following pancreatic or bariatric surgery.

Symptoms of EPI are often nonspecific and overlap with other gastrointestinal conditions, including irritable bowel syndrome, inflammatory bowel disease, celiac disease, and small intestinal bacterial overgrowth. Despite this, fewer than 7% of patients with chronic pancreatitis or pancreatic cancer are tested for EPI. As a result, clinicians should remain alert to symptoms such as bloating, diarrhea, and unexplained weight loss.

“If the patient tells you that they have gas, bloating, soft bowel movements, but they’re losing weight, that weight loss should be a major red flag that something is going on,” Gelrud said.

Ruling out EPI in these cases is critical, particularly among patients who report planning meals around anticipated bowel movements. By the time classic symptoms such as steatorrhea emerge, severe pancreatic dysfunction, often reflecting up to 90% loss of exocrine function, may already be present.

To learn more about diagnostic tools for EPI, follow part 2 of this interview.

Editor’s Note: Gelrud reports no relevant disclosures.

de Rijk FEM, van Veldhuisen CL, Besselink MG, et al. Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study. 

https://doi.org/10.1016/j.pan.2022.03.013

Ghodeif AO, Azer SA. Pancreatic Insufficiency. PubMed. Published 2023. 

https://www.ncbi.nlm.nih.gov/books/NBK555926/

Gerlud explains why exocrine pancreatic insufficiency is often missed, even in high-risk patients. 


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

Piotr Witkowski, MD, PhD, is a professor of surgery in the Transplantation Institute at the University of Chicago.

Tegoprubart Improves Glycemic Control Following Islet Transplantation for T1D, With Piotr Witkowski, MD, PhD

On March 16, 2026, Eledon Pharmaceuticals announced updated results from an investigator-initiated trial of the investigative anti-CD40L monoclonal antibody tegoprubart in patients undergoing allogeneic islet transplant for long-standing 

Advanced Technologies and Treatments for Diabetes (ATTD)

 conference in Barcelona, Spain, from March 11-14, 2026, these data build on previously released data highlighting the drug’s efficacy in both immunosuppression and insulin independence at 4 weeks post-transplant.

Pancreatic islet transplantation is a minimally invasive procedure created to provide blood glucose control in T1D while minimizing insulin dependence. Clinicians isolate pancreatic islets containing insulin-producing beta cells from the pancreas of an organ donor and infuse these cells into the liver via a small catheter. The cells then lodge in small blood vessels in the liver and produce insulin.

“The patient still needs to take anti-rejection immunosuppression medication following implantation,” Piotr Witkowski, MD, PhD, professor of surgery in the Transplantation Institute at the University of Chicago, told 

 in an exclusive interview. “However, the toxicity of this immunosuppression medication has been a major barrier to this therapy; to that end, we have been testing a new medication, tegoprubart, and the results are really promising, with almost no toxicity.”

Tegoprubart is a humanized monoclonal antibody designed to selectively inhibit CD40 ligand, a co-stimulatory molecule in T cell activation. In addition to islet transplantation, tegoprubart is currently being explored for kidney allograft transplantation, xenotransplantation, liver allograft transplantation, and amyotrophic lateral sclerosis.

This pilot study investigated a total of 12 adults with long-standing T1D who underwent allogeneic islet transplant at UChicago Medicine. These patients had a median T1D duration of roughly 33 years and a mean hemoglobin A1c of roughly 8% before transplantation. Participants were given tegoprubart as part of a calcineurin inhibitor-free immunosuppression regimen.

Ultimately, Witkowski and colleagues saw rapid improvement in glycemic control after transplantation. Stable islet graft function was observed across the cohort, with all 10 patients who were >4 weeks post-transplant achieving both insulin independence and a most recent HbA1c of <6%. Among those 10 patients, the mean most recent HbA1c was roughly 5.35%.

Tegoprubart-based immunosuppression was largely well-tolerated during the trial, with reported adverse events successfully treated through lowering of the mycophenolic acid dose where necessary. Additionally, investigators reported no rejection episodes, and no patients developed de novo donor-specific HLA antibodies. No evidence of nephrotoxicity, hypertension, or neurotoxicity, all of which are commonly associated with tacrolimus-based immunosuppression regimens, was observed.

These advancements are particularly significant because patients with T1D in America have limited access to islet transplantation therapy. Current guidelines refer to human islets as a drug rather than an organ for transplantation, meaning they are regulated by the US Food and Drug Administration (FDA) rather than the Health Resources and Services Administration (HRSA). This means that islets currently require a stringent Biologics License Application (BLA).

“One key point I would like to add is that, although we’ve been optimizing islet transplantation for over 20 years, it is still not available to patients with T1D in the US because of outdated regulations,” Witkowski said. “And we, as a transplant community, experts in the field, are advocating for a regulatory update, so that we can help more patients and progress the field faster.”

Eledon Pharmaceuticals. Eledon Announces Updated Data from Investigator-Initiated Islet Transplant Trial of Tegoprubart in Patients with Type 1 Diabetes at UChicago Medicine. March 16, 2026. Accessed March 24, 2026. 

https://ir.eledon.com/news-releases/news-release-details/eledon-announces-updated-data-investigator-initiated-islet

Brooks A. Tegoprubart Enables Insulin Independence in Type 1 Diabetes Islet Transplantation Study. 

. March 16, 2026. Accessed March 24, 2026. 

https://www.hcplive.com/view/tegoprubart-enables-insulin-independence-in-type-1-diabetes-islet-transplant-study

Witkowski discusses the data presented at ATTD 2026, highlighting the investigative anti-CD40L monoclonal antibody in facilitating insulin independence.

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Julia W. Angkeow, a PhD candidate and former research technologist at Johns Hopkins Medicine

IgG Reactivity Patterns in Pediatric Food Allergy, With Julia Angkeow

New findings suggest that immunoglobulin G (IgG) responses may provide mechanistic insight into pediatric

 with children with peanut and egg allergies showing increased IgG reactivity to food allergen peptides in early childhood.

The analysis, conducted using Phage ImmunoPrecipitation Sequencing (PhIP-Seq), included 458 children from the Boston Birth Cohort. Among them were 80 children with food allergies, 151 with sensitization, and 227 non-allergic controls. Investigators profiled IgG responses to thousands of peptide epitopes at birth and in early childhood.

Compared to controls, peanut-allergic children had greater IgG reactivity to 24 peanut peptides, and egg-allergic children had greater IgG reactivity to 17 egg peptides. These differences were not observed in cord blood, suggesting that postnatal immune development plays a central role.

The study showed modest correlations between IgE and IgG measurements for peanut (

 =.034) in peanut-allergic children, for egg (

 =.24) in egg-allergic children, and for wheat (

 < 0.01) in children with any food allergy.

“These modest correlations suggest that IGE and IgG are partially related, but they're distinct parts of the immune response,” Julia W. Angkeow, a PhD candidate at the Washington University School of Medicine in St. Louis and former research technologist at Johns Hopkins Medicine, told 

 “PhIP-Seq captures all IgG subclasses, which reflects…a broader antigen exposure and immune memory.”

Milk allergy presented a distinct pattern. Lower IgG reactivity to 8 milk peptides was observed in cord blood among children who later developed milk allergy, alongside reduced IgG responses to enteroviral peptides in childhood (all FDR <0.05). These findings may reflect altered early immune priming and are consistent with aspects of the hygiene hypothesis, although causality has not been established.

Angkeow cautioned that IgG profiling, particularly via PhIP-Seq, is not intended for clinical diagnosis of food allergy. Instead, the technology provides a high-throughput, low-cost method for mapping epitope-level immune responses across thousands of antigens simultaneously, thereby far exceeding the scope of conventional ELISA assays. Epitope-level IgG profiling may help differentiate tolerance from sensitization and inform early risk stratification, but longitudinal studies beginning in pregnancy and extending through early childhood will be needed to determine whether these IgG patterns are predictive markers or downstream consequences of allergic disease.

“I think that IgG reactant profiling could eventually inform early risk stratification or prevention strategies if the patterns that we're seeing or specific patterns in general are consistently replicated, and if they always come before allergy development across multiple different cohorts,” Angkeow said, “But we're not there yet, and there needs to be a lot of replication and mechanistic validation and protective studies before we can translate this into prevention strategies.”

Angkeow JW, Hong X, Thakar M, et al. Diverse food allergen IgG reactivities are associated with food allergies in the Boston Birth Cohort. Allergy. 2026. doi:10.1111/all.70246. 

https://pubmed.ncbi.nlm.nih.gov/41689198/

Angkeow J. Early-Life IgG Patterns Linked to Childhood Food Allergy, With Julia Angkeow. HCPLive. Published February 24, 2026. Accessed on March 24, 2026. 

https://www.hcplive.com/view/early-life-igg-patterns-linked-childhood-food-allergy-julia-angkeow

Angkeow discusses a recent study finding that PhIP-Seq analysis links diverse IgG responses to food allergy phenotypes.

Food Allergy

Akl Fahed, MD, MPH, Interventional Cardiologist at Massachusetts General Hospital and Instructor in Medicine at Harvard Medical School.

A metabolic polygenic risk score built from 20 traits and more than 8.5 million individuals outperformed existing disease-prediction models.

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When DNA Meets BMI: A New Way to Predict Metabolic Disease Earlier, With Akl Fahed, MD, MPH

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Chris Bunick, MD, PhD, and Lindsay Ackerman, MD, preview the 2026 American Academy of Dermatology Annual Meeting.

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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.

ABCs in Dermatology: Previewing the 2026 AAD Annual Meeting

Hear Martha Gulati, MD, MS, reveal how mentorship and have shaped her career in women’s heart care.

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This podcast is available via video on YouTube and on the HCPLive Cardiology podcast platforms on popular audio players.

Moving the Needle in Medicine: Blazing a Trail in Cardiology, with Martha Gulati, MD, MS

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

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This release by Apogee Therapeutics highlights findings from the phase 2 APEX trial on zumilokibart (APG777) in adults with moderate to severe atopic dermatitis.

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APEX: Zumilokibart Shows Durable Response at 52 Weeks in Atopic Dermatitis

David Fleischer, MD, professor of pediatrics at Children’s Hospital Colorado.

In this Q&A, Fleischer discusses clinically meaningful gains in peanut allergy desensitization, strong response rates, and the path toward FDA submission for VP250.


VIASKIN Peanut Patch Shows Strong Phase 3 VITESSE Results, With David Fleischer, MD

Victoria Johnson joined MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and is now an assistant managing editor for HCPLive and RheumatologyLive. She doesn’t have enough time for her numerous hobbies. You can reach her at vjohnson@mjhlifesciences.com.

Phase 3b ENCORE shows inhaled ARIKAYCE boosts culture conversion and symptoms in antibiotic‑naïve MAC lung disease, paving way for 2026 label expansion.

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ENCORE: ARIKAYCE Meets End Points, Improves Respiration in MAC Lung Disease

Pamela B. Morris, MD, is a professor of medicine in Cardiology and the Paul V. Palmer Chair of Cardiovascular Disease Preventionat the Medical University of South Carolina. 

New dyslipidemia guidance sharpens risk with CAC, checks lipoprotein(a), and targets LDL goals using expanded therapies for prevention.

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Behind the Guidelines: Top Clinical Takeaways From the 2026 Dyslipidemia Guidelines

New dyslipidemia guidance sets LDL targets for FH, urges genetic testing, and highlights evinacumab and APOC3 drugs for severe triglycerides.

Expert Insights: Recommendations on FH, Triglycerides in 2026 Dyslipidemia Guidelines

Understanding Secondary Prevention Goals, Novel Lipid Therapies from 2026 Dyslipidemia Guidelines

Trials show most heart supplements don’t lower LDL or prevent events; learn why omega‑3s, vitamins and red yeast rice fall short of statins.

Latest News

Updated ACC/AHA Dyslipidemia Guidelines Incorporate LDL-C Goals, Lp(a) Focus, With Deepak Bhatt, MD, MPH

The Case for Delabeling NNAALs in Obstetric Care, With Chang Su, MD

Why Exocrine Pancreatic Insufficiency Is Frequently Underdiagnosed, With Andres Gelrud, MD

Tegoprubart Improves Glycemic Control Following Islet Transplantation for T1D, With Piotr Witkowski, MD, PhD

IgG Reactivity Patterns in Pediatric Food Allergy, With Julia Angkeow