A Synopsis of the 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for Lipid Management for Cardiovascular Disease Risk Reduction
Methodological detailsGRADE (Grading of Recommendations Assessment, Development and Evaluation) system
- GRADE (Grading of Recommendations Assessment, Development and Evaluation) system
Recommendations
As issued by the authors
This update recommends the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator for risk estimation in primary prevention and removes a previous recommendation against routine lipid monitoring.
Coronary artery calcium testing is suggested for patients with clinical uncertainty and intermediate-to-high calculated risk
one-time lipoprotein(a) testing is recommended to identify patients with enhanced cardiovascular risk.
For primary prevention, moderate-intensity statins remain the recommended treatment for those at higher risk and should be considered for those at intermediate risk.
A new recommendation suggests moderate-intensity statins for adults living with HIV even when 10-year risk is low.
For very high-risk patients with atherosclerotic cardiovascular disease, the guideline now suggests combination therapy with high-intensity or maximally tolerated statins plus ezetimibe and/or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.
For statin-intolerant patients, alternatives include bempedoic acid, ezetimibe, fibrates, or PCSK9 monoclonal antibody inhibitors.
Original publication
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