198 - Lp(a), ApoB, and CAC: Navigating the 2026 Dyslipidemia Guideline Alphabet Soup
HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast
Sean P. Kane, PharmD, BCPS
4.9 • 650 Ratings
🗓️ 4 June 2026
⏱️ 57 minutes
🧾️ Download transcript
Summary
In this episode, we review key updates from the 2026 ACC-AHA Guidelines on the Management of Dyslipidemia.
Key Concepts
- The PREVENT ASCVD equation is now recommended to calculate ASCVD risk, with thresholds at 3%, 5%, and 10%. The previous 7.5% threshold for statin treatment is now 5%.
- In addition to the 10-year ASCVD estimate, clinicians should consider the use of Lp(a), "risk enhancers", and coronary artery calcium (CAC) scans as a "tie breaker" with shared decision-making when the decision to treat is not clear.
- In addition to LDL goals of < 100, < 70, or < 55 (depending on risk), the new guidelines also suggest non-HDL-C and apoB goals once LDL cholesterol is at goal.
- Many patients will require non-statin therapies to achieve lipid goals. The recommended non-statin therapies include ezetimibe, PCSK9 mAb, PCSK9-interfering RNA, and bempedoic acid.
References
- Writing Committee Members, Blumenthal RS, Morris PB, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(17):e1154-e1276. doi:10.1161/CIR.0000000000001423
- Wiggins BS, Barac A, Benziger CP, et al. 2026 Dyslipidemia Guideline-at-a-Glance. J Am Coll Cardiol. 2026;87(19):2617-2623. doi:10.1016/j.jacc.2026.02.4872
- Superko H, Garrett B. Small Dense LDL: Scientific Background, Clinical Relevance, and Recent Evidence Still a Risk Even with 'Normal' LDL-C Levels. Biomedicines. 2022;10(4):829. Published 2022 Apr 1. doi:10.3390/biomedicines10040829
Transcript
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| 0:00.0 | Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions. |
| 0:11.0 | This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy. |
| 0:17.0 | This podcast contains general information for educational purposes only. This is not professional |
| 0:22.4 | advice and should not be used in lieu of obtaining advice from a qualified health care provider. |
| 0:27.2 | And now on to the show. |
| 0:31.2 | Welcome to Helix Talk, episode 198. I'm your co-host, Dr. Kane. And I'm Dr. Patel. And the title of today's episode is Alpa, APOB, NCA, NCAC, navigating the 2026 Disopidemia |
| 0:45.0 | Guideline Alphabet Soup. |
| 0:47.3 | So, Dr. Patel, I'm sure you've heard that there are some new lipid guidelines that |
| 0:51.4 | were recently published, and we're going to be talking about those from the |
| 0:54.2 | ACC AHA. They're the 2026 guidelines on management of dyslipidemia today. |
| 1:00.0 | You know, this episode could not have come earlier enough, Dr. Kane, because I could not |
| 1:03.9 | escape hearing about these guidelines. It's been everywhere. So we're so happy to finally |
| 1:08.8 | talk about it. But before we jump into the guidelines |
| 1:11.9 | and how they were updated and stuff, maybe we can present a quick clinical case that we can |
| 1:16.4 | apply the findings or the updates of these guidelines. Let's say you have Rodney, who's a 54-year-old |
| 1:22.1 | male. Past medical history is significant for controlled hypertension, newly diagnosed with |
| 1:26.9 | type 2 diabetes, and obesity |
| 1:29.0 | with the BMI of 35. |
| 1:31.3 | His anti-hypertensive and anti-hyperglycemic therapies are optimized, but overall, ASIVITY |
| 1:37.9 | risk reduction still needs to be addressed. |
| 1:40.6 | The most recent fasting lipid panel shows total cholesterol of 198, LDL of 128, triglycerids of |
| 1:47.7 | 201, and HDL of 27. So we're kind of looking at that mixed dysabidemia picture here. |
... |
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