Beyond LDL-C: Modern Lipid Management for ASCVD Prevention in Primary Care

Prevention of atherosclerotic cardiovascular disease (ASCVD) is fundamental for both cardiologists and primary care physicians. From risk estimation to medical therapy for primary and secondary prevention, management is evolving with increasing evidence. Risk estimation is moving toward a model that emphasizes lifetime risk in addition to traditional shorter-term risk and takes a holistic view of individual patient cardiovascular risk, accounting for genetic predisposition and risk-enhancing comorbid conditions. Lipoprotein(a) and apolipoprotein B measurement and coronary artery calcification (CAC) scoring have emerged as tools for identifying residual risk and making decisions in cases of borderline risk. While statins remain foundational to management, newer treatment paradigms emphasize early intensification of therapy and addition of non-statin agents. These trends are reflected in recent guideline updates from the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS). In the future, polygenic risk scoring and RNA-based therapies may offer opportunities to identify and treat those at highest residual risk.