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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