Should statin therapy be routinely initiated in middle‑aged adults with at least one atherosclerotic cardiovascular disease risk factor and LDL‑C levels above 100 mg/dL? Observational data consistently shows that lower LDL-C and non-HDL-C levels are associated with substantially reduced risks of atherosclerotic vascular disease. In the absence of randomized trial data in younger and middle-aged adults with low 10–30‑year risk, the role of additional risk stratification tools—such as hsCRP and coronary artery calcium scoring—becomes critical in guiding individualized decisions about when to begin lipid-lowering pharmacotherapy.

In this interview, William E. Boden MD, FACC and Roger S. Blumenthal, MD, FACC discuss 'Lower LDL-C for Longer? Defining the Optimal Timing and Intensity of Rx'.

The 2026 ACC/AHA Dyslipidemia Guidelines highlight that Lp(a) confers a graded ASCVD risk, with levels around 125 nmol/L (50 mg/dL) indicating meaningful risk and ~250 nmol/L (100 mg/dL) identifying a substantially higher‑risk phenotype. Coronary artery calcium scoring and hsCRP are recommended selectively to refine risk assessment when traditional estimates are uncertain. Importantly, harmonization with the ESC/EAS guidelines reinforces a unified approach to prevention. Overall, the message is to keep prevention simple — start with accurate risk assessment and prioritize blood pressure and lipid management, beginning with optimization of diet and physical activity.

In this interview, Kim Allan Williams, Sr., MD, MACC and Roger S. Blumenthal, MD, FACC discuss key takeaways from the 2026 Dyslipidemia Guideline.

ardiac and hepatic function are closely interconnected, with deterioration in one organ often accelerating disease progression in the other. Emerging evidence, including data suggesting semaglutide may slow or halt liver fibrosis progression, highlights the need to rethink how we manage patients with overlapping heart and liver disease. By examining the heart–liver axis, clinicians can gain insight into more integrated approaches to care and consider why this clinically important connection has only recently gained broader attention.

In this interview, Richard A. Chazal MD, MACC and Vishal N. Rao, MD, MPH examine the interconnectedness of cardiovascular (CV) and hepatic risk.