ASCVD Risk Assessment and LDL-C Management

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.

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.