JCL roundtable: Lipid treatment targets

Area of Science:

• Cardiovascular Medicine
• Clinical Lipidology
• Atherosclerosis Research

Background:

• Current clinical practice relies on atherogenic risk markers and treatment targets for managing cardiovascular disease.
• Established guidelines, such as the ACC/AHA/Multisociety Cholesterol Guidelines, shape lipid management strategies.
• Certain biomarkers, like high-density lipoprotein cholesterol and lipoprotein(a), are associated with risk but not primary treatment targets.

Purpose of the Study:

• To examine the risk marker framework supporting current cholesterol guidelines.
• To understand the practical application of atherogenic risk markers and treatment targets in daily clinical lipidology.
• To discuss the evolving landscape of lipid management, including advanced testing and risk assessment.

Main Methods:

• Roundtable discussion among clinical lipidologists.
• Review of current ACC/AHA/Multisociety Cholesterol Guidelines.
• Analysis of prominent atherogenic risk markers and their role as treatment targets.
• Discussion of advanced lipid testing and vascular imaging, including coronary artery calcium scoring.

Main Results:

• Low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol remain central treatment targets.
• A novel LDL-C calculation offers improved accuracy over the Friedewald calculation.
• Treatment goals for LDL-C include absolute thresholds (e.g., <70 mg/dL) and relative reductions (e.g., ≥50%).
• Treatment timing (earlier, milder vs. later, stronger) is a key consideration in atherosclerotic progression.

Conclusions:

• Clinical lipidologists prioritize LDL-C and non-HDL-C for managing atherogenic risk.
• Accurate LDL-C measurement and guideline-directed goals are crucial for cardiovascular risk reduction.
• Advanced lipid testing and vascular imaging complement traditional risk assessment to guide personalized treatment strategies.