AHA 2025 Guidelines: Dyslipidemia

Management of Dyslipidemia

1. Risk Stratification (Foundation)

Management is driven by overall cardiovascular risk rather than LDL alone

Major risk categories:

Established ASCVD (very high risk)

Diabetes mellitus

Severe hypercholesterolemia (LDL ≥190 mg/dL)

Primary prevention based on risk calculators

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2. Lifestyle Modification (First-line for all)

Diet

Reduce saturated & trans fats

Increase fiber (fruits, vegetables, whole grains)

Mediterranean/DASH-style diet

Limit refined sugars

Exercise

≥150 min/week moderate intensity

Weight

Target BMI <25 kg/m²

Others

Smoking cessation

Limit alcohol

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3. Pharmacologic Therapy

A. Statins (First-line)

↓ LDL by 30–60%

Stabilize plaques

High-intensity statins

Atorvastatin 40–80 mg

Rosuvastatin 20–40 mg

Indications

ASCVD → high-intensity

LDL ≥190 → high-intensity

Diabetes (age 40–75) → moderate/high

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B. Non-Statin Therapies

Ezetimibe

Add if LDL target not achieved with statin

PCSK9 inhibitors

Alirocumab, Evolocumab

For very high-risk or statin intolerance

Bempedoic acid

Alternative in statin intolerance

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C. Hypertriglyceridemia Treatment

TG 150–499 mg/dL

Lifestyle + statins

TG ≥500 mg/dL (pancreatitis risk)

Fibrates (Fenofibrate)

Omega-3 fatty acids

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4. LDL Targets (Guideline-Oriented)

Very high risk: <55 mg/dL

High risk: <70 mg/dL

Moderate risk: <100 mg/dL

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5. Special Situations

Diabetes

Statin for all ≥40 years

Chronic kidney disease

Statin ± ezetimibe

Statin intolerance

Try lower dose / alternate statin

Add non-statin agents

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6. Monitoring

Lipid profile: baseline, then 4–12 weeks after therapy

Liver enzymes (if indicated)

CK (only if muscle symptoms)

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7. Key Takeaways

Lifestyle + statin = cornerstone

Treat risk, not just numbers

Add ezetimibe → PCSK9 if targets unmet

Treat high triglycerides to prevent pancreatitis

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𝘼𝙣𝙩𝙞𝙘𝙤𝙖𝙜𝙪𝙡𝙖𝙩𝙞𝙤𝙣 𝘼𝙛𝙩𝙚𝙧 𝙎𝙩𝙧𝙤𝙠𝙚 in Patient with AF and acute IS/TIA European Heart Association Guideline recommends: • 1 days after TIA • 3 days after mild stroke • 6 days after moderate stroke • 12 days after severe stroke Early anticoagulation can decrease a risk of recurrent stroke and embolic events but may increase a risk of secondary hemorrhagic transformation of brain infarcts. The 1-3-6-12-day rule is a known consensus with graded increase in delay of anticoagulation between 1 and 12 days after onset of ischemic stroke or transient ischemic attack(TIA), according to neurological severity based on European expert opinions. However, this rule might be somewhat later than currently used in a real-world practical setting.

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