Journal of clinical lipidology最新文献

{"title":"Association of remnant cholesterol with prognosis in atherosclerotic cardiovascular disease: A systematic review and meta-analysis","authors":"Yanyu Pei MM,&nbsp;Bo Liu MM,&nbsp;Ying Gu BSc","doi":"10.1016/j.jacl.2026.07.018","DOIUrl":"10.1016/j.jacl.2026.07.018","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Elevated remnant cholesterol (RC) is implicated in the pathogenesis of atherosclerosis.</div></div><div><h3>OBJECTIVE</h3><div>To assess the prognostic role of RC in atherosclerotic cardiovascular disease.</div></div><div><h3>METHODS</h3><div>We systematically searched PubMed, Embase, the Cochrane Library, and Web of Science from inception to January 18, 2026, for eligible studies. The primary outcome was a composite of major adverse cardiovascular events (MACE). Pooled hazard ratios (HRs) with 95% CIs were calculated using a random-effects model.</div></div><div><h3>RESULTS</h3><div>Twenty-one studies involving 114,592 participants were included. Higher RC levels were significantly associated with an increased risk of MACE (HR: 1.44, <em>P</em> &lt; 0.001), all-cause mortality (HR: 1.40; <em>P</em> &lt; 0.001), myocardial infarction (MI) (HR: 1.35; <em>P</em> &lt; 0.001), stroke (HR: 1.21; <em>P</em> = 0.004), cardiac death (HR: 1.41; <em>P</em> &lt; 0.001), and unplanned repeat revascularization (HR: 1.56; <em>P</em> &lt; 0.001). Furthermore, each 1-SD increment in RC level was associated with an elevated risk of MACE (HR: 1.22; <em>P</em> &lt; 0.001), all-cause mortality (HR: 1.16; <em>P</em> = 0.010), MI (HR: 1.11; <em>P</em> &lt; 0.001), and unplanned repeat revascularization (HR: 1.31; <em>P</em> = 0.007). The association between RC levels and MACE risk was potentially modified by geographic region, body mass index, current smoking status, adjustment for traditional lipid parameters, and study quality.</div></div><div><h3>CONCLUSION</h3><div>Elevated RC is associated with a worse prognosis in patients with established coronary artery disease. This association persisted after adjustment for traditional cardiovascular risk factors in the included studies, although residual confounding cannot be excluded. These findings suggest that RC assessment may have potential value within secondary prevention strategies for coronary artery disease.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 1799-1815"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond sitosterol: A multivariable sterol model improves diagnosis of pediatric sitosterolemia in the gray zone","authors":"Mengyuan Wu MSc,&nbsp;Hongjiang Wu BSc,&nbsp;Weihua Sun MSc,&nbsp;Yan Sun MD,&nbsp;Bingbing Wu MD,&nbsp;Feihong Luo MD,&nbsp;Zhou Pei MD,&nbsp;Wei Lu MD","doi":"10.1016/j.jacl.2026.07.030","DOIUrl":"10.1016/j.jacl.2026.07.030","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Patients with sitosterolemia (ST) are often misdiagnosed as familial hypercholesterolemia (FH) because of overlapping lipid phenotypes. Sitosterol is considered a disease-specific biomarker; however, its diagnostic utility in highly heterogeneous populations—particularly among children—remains unclear.</div></div><div><h3>OBJECTIVE</h3><div>To evaluate the diagnostic value of phytosterol biomarkers and develop a multivariate model to improve the diagnostic accuracy of ST.</div></div><div><h3>METHODS</h3><div>We conducted a cross-sectional study of 379 children with suspected lipid disorders: ST (n = 38), <em>ABCG5/8</em> heterozygous carriers (n = 12), genetically confirmed FH (n = 54), individuals with FH-like (n = 50), and healthy controls (n = 225). Clinical characteristics, lipid profiles, phytosterols, liver enzymes, and genetic data were collected. The diagnostic performance of single biomarkers and a multivariate model was evaluated. A clinical gray zone based on sitosterol levels was defined to assess the models’ ability.</div></div><div><h3>RESULTS</h3><div>Sitosterol demonstrated near-perfect discrimination for ST in the overall population area under the curve ([AUC] 0.994; 95% CI, 0.988-1.000), outperforming conventional lipid markers. However, substantial overlap in phytosterol distributions was observed among ST, heterozygotes, and FH-related phenotypes. Within the gray zone (sitosterol: 17.7-50 μg/mL), the diagnostic performance of sitosterol declined markedly (AUC 0.653). The multivariable model demonstrated comparable overall performance (AUC 0.983) but significantly improved discrimination in the gray zone (AUC 0.806), with good calibration and greater net clinical benefit.</div></div><div><h3>CONCLUSION</h3><div>Although sitosterol is highly effective for identifying ST, its diagnostic performance declines significantly in clinically significant gray zone cases. A combined sterol-based model improves diagnostic discrimination in these challenging scenarios and supports a stepwise diagnostic strategy for children with suspected ST.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 1898-1908"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel VPS4A variant drives lipotoxicity underlying CIMDAG syndrome","authors":"Apurva Gupta MD,&nbsp;Yogendra Pratap Mathuria MD,&nbsp;Buddhi Prakash Jain PhD,&nbsp;Shailesh Kumar Gupta PhD,&nbsp;Debasish Kumar Ghosh PhD","doi":"10.1016/j.jacl.2026.07.007","DOIUrl":"10.1016/j.jacl.2026.07.007","url":null,"abstract":"<div><div>Cerebellar hypoplasia, impaired intellectual development, congenital microcephaly, dystonia, anemia, and growth retardation (CIMDAG) syndrome is caused by variants in <em>VPS4A</em>. We report a 5-year-old Nepalese boy with classical CIMDAG features, including developmental delay, microcephaly, dystonia, cataracts, dyserythropoietic anemia, and growth retardation. Magnetic resonance imaging showed mild cerebellar atrophy. Trio exome sequencing identified a homozygous <em>VPS4A</em> variant (c.863G&gt;A; p.Arg288Gln), predicted to be deleterious. Structural analyses revealed disruption of a conserved Arginine-288 residue within the ATPases associated with diverse cellular activities domain, leading to loss of stability and increased disorder. The <em>VPS4A</em>-p.Arg288Gln variant showed enhanced aggregation and reduced interaction with LC3B (microtubule-associated protein 1 light chain 3 beta), impairing its localization to lipid droplets. Proband fibroblasts exhibited increased lipid accumulation, elevated free fatty acids, and higher reactive oxygen species levels, indicative of lipotoxic stress. Together, these findings demonstrate that a novel pathogenic <em>VPS4A</em> variant drives structural destabilization and lipotoxicity, providing mechanistic insight into lipid homeostasis perturbations in CIMDAG syndrome.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 2069-2077"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonstatins for LDL-C lowering: An expansion whose time has come","authors":"Joseph J. Saseen PharmD,&nbsp;Dave L. Dixon PharmD","doi":"10.1016/j.jacl.2026.04.017","DOIUrl":"10.1016/j.jacl.2026.04.017","url":null,"abstract":"<div><div>The 2026 American College of Cardiology/American Heart Association/Multisociety Dyslipidemia Guideline marks a defining moment for lipidology with the reinstatement of low-density lipoprotein cholesterol (LDL‑C) and non–high-density lipoprotein cholesterol treatment goals and a decisive endorsement of combination lipid‑lowering therapy. Although statins remain foundational, statin monotherapy often fails to achieve sufficient LDL‑C lowering, particularly in high-risk patients or patients with statin intolerance or refusal. These realities elevate nonstatin therapies from secondary considerations to core components of evidence‑based care. This commentary reviews the expanded role of currently available nonstatin agents across all guideline‑defined treatment groups. New outcomes data further strengthen the rationale for greater LDL‑C reduction in high‑risk primary prevention populations and reinforce the “lower is better” principle central to lipidology. Finally, we explore the rapidly evolving pipeline of next‑generation LDL‑C–lowering therapies, including long‑acting injectables and oral proprotein convertase subtilisin/kexin type 9 inhibitors, that promise to further individualize care and address longstanding barriers to adherence and goal attainment. These advances underscore a new lipid‑lowering paradigm that includes combination therapy to achieve and sustain optimal LDL‑C levels and meaningfully reduce atherosclerotic cardiovascular disease risk.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 22-24"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JCL Roundtable: Rewriting the rules for primary prevention: New outcomes from intensive LDL-C reduction in high-risk patients","authors":"Robert P. Giugliano MD, SM,&nbsp;Nicholas A. Marston MD,&nbsp;Kevin C. Maki PhD, CLS, MNLA, FTOS, FAHA","doi":"10.1016/j.jacl.2026.07.021","DOIUrl":"10.1016/j.jacl.2026.07.021","url":null,"abstract":"<div><div>This <em>Journal of Clinical Lipidology</em> Roundtable presents a conversation between Drs Robert P. Giugliano, Nicholas A. Marston, and Kevin C. Maki, who discussed clinical trials investigating intensive low-density lipoprotein cholesterol (LDL-C) reduction in high-risk patients. Their focus was on cardiovascular outcomes data from the recent Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke (VESALIUS-CV) trial, as well as earlier secondary prevention outcomes trials for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor monoclonal antibody agents: Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) and Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment with Alirocumab (ODYSSEY Outcomes). In addition to comparing and contrasting the study designs, populations enrolled, and primary endpoint results between these primary and secondary prevention trials, the group also discussed high-risk subgroups and the important role of imaging in primary prevention, as well as the potential implications of recent trial findings on guideline recommendations for LDL-C treatment goals. Their conversation emphasized 2 themes demonstrated in recent data: (1) the importance of aggressively treating LDL-C earlier, and (2) the benefits in high-risk primary prevention of reducing LDL-C to lower levels than those recommended in current guidelines.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 1744-1750"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of different statin intensities combined with ezetimibe on lipid profile improvement in patients with coronary heart disease: A network meta-analysis","authors":"Qingsheng Niu MD,&nbsp;Peng Yao MD, PhD,&nbsp;Lu Gan MD, PhD,&nbsp;Ling Wang MS,&nbsp;Yaowen Jiang MD,&nbsp;Yu Cao MD, PhD","doi":"10.1016/j.jacl.2026.07.017","DOIUrl":"10.1016/j.jacl.2026.07.017","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Despite statin medication, a substantial number of patients with coronary heart disease (CHD) do not meet guideline-recommended lipid goals, increasing dependence on combination lipid-lowering methods. However, evidence comparing the lipid-modifying effectiveness of ezetimibe added to statins of varying intensities is lacking, creating confusion about the best treatment options in clinical practice. This research sought to assess and compare the effectiveness of statins of varying intensities in conjunction with ezetimibe for enhancing lipid profiles in individuals with CHD.</div></div><div><h3>SOURCES OF MATERIAL</h3><div>PubMed, Embase, Cochrane Library, and Web of Science were searched to January 1, 2026 for randomized controlled trials (RCTs) comparing statin monotherapy with statin-ezetimibe therapy in CHD. Network meta-analysis was performed using Stata 17.0, with surface under the cumulative ranking curve-based ranking. Outcomes were low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), non–HDL-C, and apolipoprotein B (ApoB).</div></div><div><h3>ABSTRACT OF FINDINGS</h3><div>A total of 38 RCTs involving 7340 patients with CHD were included. Network meta-analyses demonstrated that moderate-intensity statin (MIS) therapy coupled with ezetimibe regularly resulted in significant enhancements in LDL-C, HDL-C, TC, non-HDL-C, and ApoB levels. For LDL-C reduction, MIS plus ezetimibe was comparable in efficacy to a high-intensity statin (HIS) plus ezetimibe. For TG, HIS combined with ezetimibe was rated highest, while no significant change was noted in comparison to MIS combined with ezetimibe. Rosuvastatin plus ezetimibe may demonstrate the greatest efficacy among MIS-based combination regimens.</div></div><div><h3>CONCLUSION</h3><div>Adding ezetimibe to MIS medication in patients with CHD provides a more balanced cholesterol-lowering strategy than statin dosage increase alone, with effectiveness equivalent to HIS-based treatment across several lipid measures.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 1751-1766"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world assessment of adherence to inclisiran dosing schedule and LDL-C reduction in patients with hypercholesterolemia in Austria","authors":"Dieter Pätzold MD,&nbsp;Alexander Vonbank MD,&nbsp;Martin Clodi MD,&nbsp;Harald Sourij MD,&nbsp;Dietmar Hubner MD,&nbsp;Christoph Ebenbichler MD,&nbsp;Ailís Fagan PhD,&nbsp;Gabriella Farries PhD,&nbsp;Elisabeth Hofstätter PhD,&nbsp;Markus Nitzlader MSc,&nbsp;Doris Gangl PhD,&nbsp;Christopher Adlbrecht MD","doi":"10.1016/j.jacl.2026.07.025","DOIUrl":"10.1016/j.jacl.2026.07.025","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Inclisiran is a small interfering RNA that safely and effectively lowers low-density lipoprotein cholesterol (LDL-C) with twice-yearly dosing (after the initial and 3-month doses). However, data on real-world inclisiran use are limited.</div></div><div><h3>OBJECTIVE</h3><div>This descriptive, noninterventional, retrospective chart review aimed to assess dosing schedule adherence, patient profiles, and LDL-C change in participants prescribed inclisiran sodium 300 mg (equivalent to 284 mg inclisiran) in routine clinical practice in Austria.</div></div><div><h3>METHODS</h3><div>Participants with atherosclerotic cardiovascular disease (ASCVD), ASCVD risk equivalent, or familial hypercholesterolemia, LDL-C ≥70 mg/dL &lt;6 months before the 1st inclisiran dose who received ≥1 inclisiran dose between February 1, 2021, and June 30, 2022, were included.</div></div><div><h3>RESULTS</h3><div>Of participants who initiated inclisiran (N = 95), 96.8% and 89.5% received the 2nd and 3rd doses, respectively, with 95.5% receiving the 2nd dose &lt;5 months of the 1st dose and 73.4% receiving the 3rd dose 6 to 9 months after the 2nd dose. At baseline, median LDL-C was high (122.0 mg/dL) despite 77.9% of participants receiving lipid-lowering therapy (LLT); concomitant LLT use was reduced to 55.8% after initiating inclisiran. Median LDL-C reduction after the 1st and 2nd doses was 44.7% and 40.8%, respectively. In a subcohort with concomitant statin use, median LDL-C reduction from baseline was 55.7% and 56.0% after the 1st and 2nd dose, respectively, with 87.9% achieving LDL-C &lt;55 mg/dL after the 2nd or 3rd dose. Absolute LDL-C reduction was consistent irrespective of concomitant statin use.</div></div><div><h3>CONCLUSION</h3><div>In a real-world setting in Austria, inclisiran demonstrated a favorable early therapeutic impact, including high adherence to the recommended dosing schedule and sustained LDL-C reductions.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 1921-1932"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between lipoprotein (a) levels and cardiac allograft vasculopathy among heart transplant recipients: Insights from a single-center cohort","authors":"Daniela Bacich MD,&nbsp;Enrico Giuseppe Italiano MD,&nbsp;Marika Faggioli MD,&nbsp;Laura Rizzo MD,&nbsp;Nicola Pradegan MD,&nbsp;Giuseppe Toscano MD,&nbsp;Chiara Tessari MD, PhD,&nbsp;Vincenzo Tarzia MD, PhD","doi":"10.1016/j.jacl.2026.07.024","DOIUrl":"10.1016/j.jacl.2026.07.024","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Serum lipoprotein (a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease in the general population, but its association with cardiac allograft vasculopathy (CAV) development has not been firmly established.</div></div><div><h3>OBJECTIVE</h3><div>To assess the distribution of Lp(a) levels in heart transplant (HT) recipients and evaluate the correlation between Lp(a) levels and the presence and severity of CAV.</div></div><div><h3>METHODS</h3><div>A retrospective observational cohort study encompassing 271 adult HT recipients on regular outpatient follow-up in a tertiary center. Lp(a) concentration was assessed during the last follow-up visit and compared between patients with and without clinically significant CAV, International Society for Heart and Lung Transplantation (grade 2-3 vs 0-1).</div></div><div><h3>RESULTS</h3><div>Median serum Lp(a) concentration was 40 nmol/L; 62 patients (23%) had Lp(a) &gt;125 nmol/L. Median Lp(a) levels did not significantly differ between patients with CAV 0-1 and patients with CAV 2-3 (median 37 vs 55 nmol/L, <em>P</em> = 0.408). High (&gt;125 nmol/L) Lp(a) levels were not associated with CAV 2-3, neither on univariable nor on multivariable analysis (hazard ratio multivariate 1.02, 95% CI: 0.35-2.95, <em>P</em> = 0.977). Elevated Lp(a) concentrations (&gt;75, &gt;125, &gt;200 nmol/L) did not show significant correlation with either CAV 2-3 nor with CAV 1-2-3. Older donor age was significantly related to CAV development (+1.018% increase of CAV for every year of increase of donor age, <em>P</em> value 0.009).</div></div><div><h3>CONCLUSION</h3><div>Elevated serum Lp(a) levels were not associated with the presence and severity of CAV in patients with HT with long post-transplant follow-up. The relationship between Lp(a) and CAV warrants further investigation, given the small sample of the current study.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 1988-1997"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We must “PREVENT” earlier to reduce lifetime exposure to LDL-C","authors":"Ann Liebeskind MD, FNLA, FAAP, FACC","doi":"10.1016/j.jacl.2026.07.001","DOIUrl":"10.1016/j.jacl.2026.07.001","url":null,"abstract":"","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 20-21"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifestyle and pharmacologic interventions for adults with hypertriglyceridemia: Critical to reduce risk of ASCVD and pancreatitis but often underutilized","authors":"Carol F. Kirkpatrick PhD, MPH, RDN, CLS, FNLA,&nbsp;Vera A. Bittner MD, MSPH, FACC, FAHA, MNLA, MAACVPR","doi":"10.1016/j.jacl.2026.05.224","DOIUrl":"10.1016/j.jacl.2026.05.224","url":null,"abstract":"<div><div>The 2026 American College of Cardiology (ACC)/American Heart Association (AHA)/Multisociety Guideline on the Management of Dyslipidemia (2026 Guideline) replaces the 2018 AHA/ACC/Multisociety Guideline on the Management of Blood Cholesterol. The 2026 Guideline expands the section on the management of hypertriglyceridemia (HTG) and acknowledges that triglyceride (TG)-rich lipoproteins contribute to atherosclerotic cardiovascular disease (ASCVD) risk. The 2026 Guideline emphasizes lifestyle interventions as the foundation of HTG management and recommends risk-based pharmacologic interventions for prevention of both ASCVD and pancreatitis. Nutritional interventions, preferably provided as medical nutrition therapy by registered dietitian nutritionists (RDNs), should be individualized based on underlying causes and degree of TG elevation. Referral rates to RDNs have been historically low, in part due to lack of awareness by providers and patients, and in part due to lack of RDN availability and lack of payer coverage. The 2026 Guideline emphasizes the importance of RDN involvement in care, especially for complex patients. Pharmacologic management requires initial and ongoing assessment of risk of ASCVD and pancreatitis, as well as modifications in therapy as appropriate. When TGs are ≥500 mg/dL, and especially ≥1000 mg/dL, preventing pancreatitis is the primary concern. Patients should be reassessed for ASCVD risk once TGs are reduced. Shared decision-making is critical to these discussions of lifestyle and pharmacologic interventions. Implementation of these recommendations necessitates clinician and patient education, as well as improvements in access and coverage for RDN involvement and combination pharmacotherapy, to enhance care of patients with HTG and reduce their risks of ASCVD and pancreatitis.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 9","pages":"Pages 25-29"},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}