Kausik Ray, MD, FMedSci

In this episode, 'Examining the 2026 ACC/AHA Dyslipidemia Guidelines for ASCVD,' the expert cardiologists explore the transition from previous guideline iterations to the current, more actionable framework for lipid management. The panelists identify several key strengths in the updated recommendations, such as lowering the LDL-C treatment threshold to 160 mg/dL for low-risk individuals and providing specific targets for non-HDL and apolipoprotein B to ensure global risk control.  A significant portion of the conversation focuses on making clinical data more formulaic and easier for practitioners to implement. Dr. Navar highlights the move toward universal Lp(a) testing and the use of concrete coronary calcium scores to guide the intensification of therapy. The experts also discuss the reintroduction of "55" as a simple, memorable target for both LDL-C and apolipoprotein B in high-risk scenarios.  The panel delves into the advantages of the PREVENT equation and the shift from 10-year to 30-year risk calculations. They emphasize that identifying risk over a longer lifespan is critical because atherosclerosis is a decades-long biological process. By starting intervention earlier, clinicians can prevent plaque buildup rather than attempting the more difficult task of regressing established plaque later in life. The discussion concludes by addressing the educational gap regarding new risk percentages, noting that a 7% or 10% score under the new equation carries a different clinical weight than older models, requiring updated communication strategies for both providers and patients.  The next episode in this series, ‘Communicating Global Cardiovascular Risk Through a Prevention Lens in ASCVD,’ features the panelists advancing their conversation on ASCVD and focusing on how clinicians can more effectively frame cardiovascular risk for patients, particularly those with high-risk conditions like type 2 diabetes, by shifting the conversation from isolated lab values to a holistic, prevention-centered approach.

Examining the 2026 ACC/AHA Dyslipidemia Guidelines for ASCVD

In this episode, 'Examining the 2026 ACC/AHA Dyslipidemia Guidelines for ASCVD,' the expert cardiologists explore the transition from previous guideline iterations to the current, more actionable framework for lipid management. The panelists identify several key strengths in the updated recommendations, such as lowering the LDL-C treatment threshold to 160 mg/dL for low-risk individuals and providing specific targets for non-HDL and apolipoprotein B to ensure global risk control.

A significant portion of the conversation focuses on making clinical data more formulaic and easier for practitioners to implement. Dr. Navar highlights the move toward universal Lp(a) testing and the use of concrete coronary calcium scores to guide the intensification of therapy. The experts also discuss the reintroduction of "55" as a simple, memorable target for both LDL-C and apolipoprotein B in high-risk scenarios.

The panel delves into the advantages of the PREVENT equation and the shift from 10-year to 30-year risk calculations. They emphasize that identifying risk over a longer lifespan is critical because atherosclerosis is a decades-long biological process. By starting intervention earlier, clinicians can prevent plaque buildup rather than attempting the more difficult task of regressing established plaque later in life. The discussion concludes by addressing the educational gap regarding new risk percentages, noting that a 7% or 10% score under the new equation carries a different clinical weight than older models, requiring updated communication strategies for both providers and patients.

The next episode in this series, ‘Communicating Global Cardiovascular Risk Through a Prevention Lens in ASCVD,’ features the panelists advancing their conversation on ASCVD and focusing on how clinicians can more effectively frame cardiovascular risk for patients, particularly those with high-risk conditions like type 2 diabetes, by shifting the conversation from isolated lab values to a holistic, prevention-centered approach.

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Welcome back to another HCPLive Peer Exchange series. In this episode titled, 'ASCVD Risk Assessment and LDL-C Management,' the moderator Dr. Kausik Ray, and expert panelists, Dr. Christie Ballantyne, Dr. Eliot Brinton, and Dr. Ann Marie Navar, discuss the current landscape of atherosclerotic cardiovascular disease (ASCVD) risk assessment and the implementation of updated clinical guidelines.

ASCVD Risk Assessment and LDL-C Management

The conversation begins with an exploration of risk calculators, noting that while 30-year risk scores help identify long term needs for patients as young as age 30, they often fail to capture the full clinical picture. Dr. Navar explains how incidental atherosclerosis and coronary calcium scores frequently supersede standard risk scores in her practice, allowing for a more personalized approach to therapy.

A major focus of the episode is the shift back toward specific LDL-C targets. The panelists praise the concordance between U.S. and European guidelines, specifically the reintroduction of numerical goals such as less than 55 mg/dL for very high-risk patients. They emphasize that these numbers serve as essential motivators for patient-physician discussions. However, despite having clear targets, the panel highlights a troubling reality: fewer than 10% of very high-risk patients in the United States currently reach the 55 mg/dL threshold. To bridge this gap, the experts advocate for a proactive shift toward combination therapy, drawing parallels to hypertension management. They conclude by addressing the underutilization of advanced tools like PCSK9 inhibitors, noting that many clinicians have yet to integrate these effective therapies into routine primary and secondary prevention.

In the next episode, 'Examining the 2026 ACC/AHA Dyslipidemia Guidelines for ASCVD,' panelists will continue their discussion on ASCVD and highlight the strengths of the updated guidelines, including the lowering of LDL-C thresholds for low-risk patients and the inclusion of universal Lp(a) testing. The experts explain how concrete guidance on coronary calcium and the shift toward 30-year risk estimates allow for earlier clinical intervention and a more personalized approach to long term prevention.

Kausik Ray, MD, FMedSci

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