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Dyslipidemia

What's new

The National Lipid Association (NLA) and the American Geriatrics Society (AGS) have published a new guideline for the management of hypercholesterolemia in adults over 75 years without a history of atherosclerotic cardiovascular disease (ASCVD). Statin therapy is suggested for patients with an LDL-C of 70-189 mg/dL for primary prevention of ASCVD, despite potential risks of statin-associated muscle symptoms, new-onset type 2 diabetes, and drug-induced cognitive impairment, provided there is no life-limiting illness. Ezetimibe is suggested for additional LDL-C and ASCVD risk reduction, and bempedoic acid is suggested for statin-intolerant patients. LDL-C monitoring every 3-12 months is recommended during treatment. Statin deprescribing is suggested in cases of life-limiting illness or an estimated survival of <1 year to improve quality of life. .

Background

Overview

Definition
Dyslipidemia is a disorder of lipid metabolism characterized by elevated LDL cholesterol, decreased HDL cholesterol and/or increased triglycerides, which contributes to the development of atherosclerosis.
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Pathophysiology
Primary dyslipidemia is due to genetic abnormalities, whereas secondary dyslipidemia is multifactorial, and is associated with obesity, physical inactivity, high-carbohydrate and high-fat diets, smoking, alcohol use, uncontrolled diabetes mellitus, hypothyroidism, renal failure, cholestatic liver disease, nephrotic syndrome, and various drugs (corticosteroids, progestogens, androgenic steroids, thiazide diuretics, beta blockers, oral estrogens, retinoic acid derivatives).
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Epidemiology
In the US, an estimated 53% of adults have at least one lipid abnormality: 27% have elevated LDL cholesterol, 23% have decreased HDL cholesterol, and 30% have increased triglycerides.
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Disease course
Lipid abnormalities contribute to the formation of atherosclerotic plaque, leading to an increased risk of CVD, stroke, and PAD.
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Prognosis and risk of recurrence
Treatment with statins is associated with a relative reduction in the risk of major adverse vascular events of 22% in men and 16% in women for every 1.0 mmol/L (38.6 mg/dL) reduction in LDL cholesterol.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of dyslipidemia are prepared by our editorial team based on guidelines from the American Association of Clinical Endocrinologists (AACE 2025), the American Diabetes Association (ADA 2025), the National Lipid Association (NLA/AGS 2025), the Society for Cardiovascular Angiography and Interventions (SCAI/NAEMSP/AHA/ACC/ACEP 2025), the National Lipid Association (NLA/PCNA/ASPC/ACC/AHA/ACCP 2023), the World Health Organization ...
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Screening and diagnosis

Indications for screening, adults, lipid profile: as per DoD/VA 2020 guidelines, consider obtaining a lipid panel no more often than every 10 years for primary prevention in patients not on statin therapy.
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  • Indications for screening (adults, ApoB and LPa)

  • Indications for screening (pediatrics)

Classification and risk stratification

Risk assessment: as per AACE 2025 guidelines, use a validated tool or calculator to predict future risk of ASCVD events in adult patients with dyslipidemia as part of shared decision-making around treatment.
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Diagnostic investigations

Lipid profile, tests: as per EAS/ESC 2020 guidelines, obtain LDL-C as the primary lipid analysis method for screening, diagnosis, and management.
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  • Lipid profile (fasting state)

  • ApoB

  • Lipoprotein(a)

  • Screening for hypothyroidism

  • Screening for anabolic steroid use

  • Coronary CT

  • Arterial ultrasound

Medical management

Treatment targets: as per AACE 2025 guidelines, consider targeting LDL-C level of < 70 mg/dL in adult patients with or at high risk of ASCVD undergoing pharmacotherapy for dyslipidemia.
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  • Statins

  • Ezetimibe

  • PCSK9 inhibitors

  • PCSK9 monoclonal antibodies

  • PCSK9-blocking siRNA

  • Icosapent ethyl

  • Fibrates

  • Bile acid sequestrants

  • Niacin

  • Bempedoic acid

Nonpharmacologic interventions

Dietary modifications: as per DoD/VA 2020 guidelines, advise following a dietitian-led Mediterranean diet for primary and secondary prevention of CVD.
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  • Physical activity

  • Smoking cessation

  • Omega-3 fatty acid supplements

  • Other supplements

Specific circumstances

Female patients: as per CCS 2021 guidelines, obtain screening with a complete lipid panel in the late postpartum period in female patients with a pregnancy complication such as the following as they have a higher risk of premature CVD and stroke with onset 10-15 years after index delivery:
hypertensive disorders of pregnancy
gestational diabetes
preterm birth
stillbirth
low birth weight infant
placental abruption.
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  • Elderly patients (clinical assessment)

  • Elderly patients (risk stratification)

  • Elderly patients (statin therapy)

  • Elderly patients (non-statin therapy)

  • Elderly patients (monitoring)

  • Elderly patients (discontinuation of treatment)

  • Pediatric patients (screening)

  • Pediatric patients (clinical assessment)

  • Pediatric patients (genetic testing)

  • Pediatric patients (lifestyle modifications)

  • Pediatric patients (statin therapy)

  • Pediatric patients (management of hypertriglyceridemia)

  • Pediatric patients (treatment targets)

  • Pediatric patients (indications for referral)

  • Patients with obesity

  • Patients with severe hypercholesterolemia

  • Patients with hypertriglyceridemia (general principles)

  • Patients with hypertriglyceridemia (statins)

  • Patients with hypertriglyceridemia (fibrates)

  • Patients with hypertriglyceridemia (omega-3 fatty acids)

  • Patients with hypertriglyceridemia (niacin)

  • Patients with hypertriglyceridemia (management of pancreatitis)

  • Patients with familial hypercholesterolemia (screening)

  • Patients with familial hypercholesterolemia (diagnosis)

  • Patients with familial hypercholesterolemia (CVD risk stratification)

  • Patients with familial hypercholesterolemia (management)

  • Patients with familial hypercholesterolemia (homozygous FH)

  • Patients with ASCVD (general indications)

  • Patients with ASCVD (chronic coronary syndrome)

  • Patients with ASCVD (acute coronary syndrome)

  • Patients with ASCVD (ischemic stroke)

  • Patients with ASCVD (PAD)

  • Patients with aortic valvular disease

  • Patients with HF

  • Patients with diabetes mellitus (evaluation)

  • Patients with diabetes mellitus (lifestyle modifications)

  • Patients with diabetes mellitus (treatment targets)

  • Patients with diabetes mellitus (statin therapy)

  • Patients with diabetes mellitus (non-statin lipid-lowering therapy)

  • Patients with diabetes mellitus (hypertriglyceridemia)

  • Patients with diabetes mellitus (lipid profile monitoring)

  • Patients with CKD (management)

  • Patients on hemodialysis

  • Patients with inflammatory diseases and HIV

  • Patients with solid organ transplants

  • Patients with endocrine disorders (evaluation)

  • Patients with endocrine disorders (thyroid disease)

  • Patients with endocrine disorders (Cushing's syndrome)

  • Patients with endocrine disorders (adult GHD)

  • Patients with endocrine disorders (acromegaly)

  • Patients with endocrine disorders (PCOS)

  • Patients with endocrine disorders (testosterone deficiency)

Patient education

Shared decision-making: as per AAPA/ABC/ACC/…/PCNA 2019 guidelines, promote shared decision-making when initiating lipid-lowering therapy, and discuss the potential benefits and adverse effects of treatments, as well as the potential for drug-drug interactions.
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Preventative measures

Fat intake
As per WHO 2023 guidelines:
Consider limiting total fat intake to ≤ 30% of total energy intake to reduce the risk of unhealthy weight gain in adults.
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Advise consuming primarily unsaturated fatty acids with ≤ 10% of total energy intake coming from saturated fatty acids and ≤ 1% of total energy intake coming from trans-fatty acids.
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Follow-up and surveillance

Monitoring for adherence to treatment: as per DoD/VA 2020 guidelines, consider offering intensified patient care (such as phone calls, emails, patient education, drug regimen simplification) to improve adherence to lipid-lowering medications.
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  • Monitoring for adverse effects of statins