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New rhythm in hyperlipidemia care
Finding a New Rhythm in Hyperlipidemia Care: The Future of Lipid Management and ASCVD Prevention

Released: February 18, 2026

Ty J. Gluckman
Ty J. Gluckman, MD, MHA
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Key Takeaways
  • Despite a robust and expanding toolkit to lower low-density lipoprotein cholesterol (LDL-C) and reduce atherosclerotic cardiovascular disease (ASCVD) risk, underuse of effective therapies persists, driven largely by clinical inertia and misconceptions rather than a true therapeutic gap.
  • Lipoprotein (a) represents a genetically driven, under-addressed contributor to ASCVD risk that warrants testing at least once in a patients’ lifetime.
  • Although targeted Lp(a)-lowering therapies are still in development, identifying elevated Lp(a) today helps with risk stratification, patient education, family screening, and guiding the intensity of existing LDL-C lowering therapies.

Across multiple cardiovascular diseases like heart failure, atrial fibrillation, and hypertension, underuse of effective therapies to lower low-density lipoprotein cholesterol (LDL-C) and reduce atherosclerotic cardiovascular disease (ASCVD) risk persists. Clinical inertia—the sense that what patients are currently receiving is good enough or is sufficiently addressing their clinical needs—has consistently been identified as a top reason for medication underuse among healthcare professionals (HCPs). Acknowledging that those who manage patients with hyperlipidemia have the full intent to minimize patients’ ASCVD risk, they also must juggle the ever-growing collection of therapies that need to be considered beyond simply targeting LDL-C.

Although some lipid-lowering therapies have historically been met with challenges regarding prior authorization and affordability, many LDL-C–lowering therapies that we use today are widely available, accessible, and affordable for patients. Because of this, there is a lot of work cut out for those of us who are interested in closing ongoing gaps in care, and HCPs need to ensure that patients’ treatment regimens adequately address existing needs.

Myths/Misconceptions About Statins
Statins are among the most commonly prescribed medications in the United States, reflecting broad awareness of their role in helping to reduce cardiovascular risk both in primary and secondary prevention. Despite this, persistent myths and misconceptions among HCPs and patients alike continue to influence their use, particularly as it relates to perceived safety concerns.

Like all medications, statins are associated with potential adverse effects; most notable among these are statin-associated muscle symptoms, including myalgia and myopathy. However, widely held beliefs that statins increase the risk of dementia, cancer, or adverse cardiovascular outcomes are not supported by the totality of available evidence, which continues to refute these claims.

In clinical practice, I do my best to acknowledge patient concerns and hesitancy about statin therapy while providing clear, evidence-based education. I also recognize that it may be difficult to do this in a way that is well-received while addressing misconceptions and aligning lipid-lowering strategies with patient goals. Although some patients may ultimately decline statin therapy despite counseling, HCPs must be prepared to engage in shared decision-making and identify alternative approaches for LDL-C lowering and ASCVD risk reduction.

How Lp(a) Is Transforming Lipid Management
Human genetic studies and observational analyses have helped establish a link between elevated levels of lipoprotein (a) (Lp[a]) and increased ASCVD risk. To this end, the National Lipid Association, the European Atherosclerosis Society, and the Canadian Cardiovascular Society recommend measuring Lp(a) in all individuals at least once in their lifetime.

Multiple new medications have demonstrated the ability to meaningfully lower Lp(a) in phase II trials. What is following are phase III trials that are evaluating the ability of these medicated to lower ASCVD risk in those with elevated Lp(a) levels. We await the results of these studies, which have the potential to refine our treatment approach in these individuals.

In the interim, patients with elevated Lp(a) levels should have their treatment approach intensified, emphasizing comprehensive lifestyle interventions, optimal treatment of ongoing comorbidities, and intensification of LDL-C lowering therapy.

Even if therapies that target Lp(a) are shown to provide significant cardiovascular benefit, I don’t think this will necessarily be a one-size-fits-all approach. In short, treatment priorities will likely follow specific lipid profiles. For patients with an elevated Lp(a) level who have achieved their LDL-C goals, shifting the focus to Lp(a) for those with significantly elevated levels makes sense. In those whose LDL-C and Lp(a) levels both remain inadequately controlled, decisions about whether to treat these lipid targets sequentially or concurrently will likely be shaped by future clinical guidance.

In addition, because we know that Lp(a) levels are largely genetically determined, there is value in letting patients know their levels before ongoing outcomes trials are completed. Elevated levels may help to explain why a patient developed cardiovascular disease, particularly if traditional risk factors are lacking. Elevated levels should also prompt family members to get their Lp(a) level measured, as it may help inform their own cardiovascular risk assessment and whether they warrant LDL-C–lowering therapy.

Barriers to the Use of Emerging Therapies
Polypharmacy and more frequent medication dosing remain major challenges for patients at increased cardiovascular risk. As the number of cardiovascular risk-reducing medications grows and the dosing frequency increases, adherence predictably declines. Even modest out-of-pocket costs can accumulate, serving as a meaningful burden for patients. These challenges are all too real for most patients with ASCVD, as multimorbidity is the norm these days. As such, each evidence-based therapy that improves cardiovascular outcomes also adds complexity to the treatment regimen.

Given this, there is now an increased focus on therapies that can deliver benefit across multiple conditions. This evolution is reflected in the American Heart Association’s Cardiovascular-Kidney-Metabolic Syndrome Presidential Advisory, which highlights shared risk factors across stages of this condition. Accordingly, medications like SGLT2 inhibitors, incretins (GLP-1 receptor agonists), and mineralocorticoid receptor antagonists may offer even greater benefit, given their ability to help treat several conditions at once.

Although statins are likely to remain as initial LDL-C lowering therapy, fixed-dose combination therapy with oral medications may be the future. Both HCPs and patients are seeking a simplified regimen with improved adherence.

Call to Action and What Lies Ahead
Even though more options for cardiovascular prevention are often sought, it may not be clear where to go next. Excitement about newer therapies will need to be balanced against the availability of effective, lower cost options that are generally well-tolerated and more affordable.

Because most cardiovascular disease is preventable, we need to figure out the best ways to prioritize those therapies that we can get into the hands of our patients. In short, newer therapies are only as good as they’re likely to be used.

Your Thoughts
Do you measure Lp(a) at least once in your patients with hyperlipidemia? You can get involved in the conversation by answering the poll question and posting a comment below.

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