Maximizing bad cholesterol reduction for effective lipid management

Current dyslipidemia treatment strategies look beyond lifestyle modifications or optimized statin monotherapy, focusing instead on early combination therapies to bring low-density lipoprotein cholesterol (LDL-C) down to target levels based on individual cardiovascular risk profiles.

Prof. Vo Thanh Nhan, MD, PhD, Director of the Interventional Cardiology Center and Deputy Director of the Cardiovascular Center at Tam Anh General Hospital, HCMC, along with fellow experts, shared this information during the scientific seminar titled “Updating dyslipidemia treatment: From 2026 AHA/ACC guidelines to clinical practice.” The event took place on June 22, 2026, at the Tam Anh Research Institute, a member of the Tam Anh General Hospital Group.

Heading towards the 5 clinical pillars of lipid control

In her presentation, “Reshaping the lipid management model in cardiovascular patients: Updates from the latest guidelines to current evidence,” Dr. Tran Thi Thanh Truc, Head of the General Internal Medicine Department at Tam Anh General Hospital, HCMC, emphasized that atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of cardiovascular mortality. The continuous rise in the ASCVD burden places an urgent demand on optimizing dyslipidemia management strategies.

The latest 2026 guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) emphasize the principles of “the lower the LDL-C, the better” and “reduce LDL-C as early as possible.” This approach aims to limit the cumulative burden of atherogenic lipoproteins and minimize the risk of long-term cardiovascular events. Statistics show that a reduction of 1 mmol/L (~39 mg/dL) in LDL-C leads to an approximate 22% decrease in major adverse cardiovascular events. Furthermore, lowering LDL-C below the threshold of 55 mg/dL has been shown to reduce the rate of major cardiovascular events by about 33%.

The contemporary approach has evolved beyond lifestyle changes or optimized statin monotherapy alone. It now targets an aggressive lipid-lowering strategy through the early combination of therapies to achieve both LDL-C and non-HDL-C targets tailored to each patient’s cardiovascular risk level. Accordingly, for patients with dyslipidemia, clinicians and patients should engage in shared decision-making regarding the patient’s ASCVD risk, viewing a healthy lifestyle as the foundation for risk reduction, alongside discussions on the benefits of lipid-lowering therapy, costs, and patient preferences to determine the optimal treatment plan.

Dr. Truc noted that the 5 clinical pillars of lipid control include: initiating lifestyle modifications early in life to minimize cumulative exposure to LDL-C (bad cholesterol); evaluating individualized risk through a Calculate-Personalize-Reclassify model; screening for Lipoprotein (a) at least once in a lifetime and monitoring Apolipoprotein B (ApoB) in patients with residual risk; achieving target LDL-C levels of < 70 mg/dL or < 55 mg/dL depending on risk stratification; and combining statins with non-statin therapies, including Inclisiran.

Combining drug classes for long-term LDL-C reduction

In the presentation “Early siRNA combination: A new approach for early and aggressive LDL-C lowering therapy in patients with Atherosclerotic Cardiovascular Disease (ASCVD),” Dr. Ho Anh Tuan from the Interventional Cardiology Center at Tam Anh General Hospital, HCMC, highlighted that ASCVD is a progressive, complex disease requiring a comprehensive therapeutic strategy. The 2026 ESC/EAS and ACC/AHA guidelines universally stress the need to manage LDL-C through early intervention, intensive reduction, and long-term maintenance.

Dr. Ho Anh Tuan stresses the critical role of combining drug classes in the treatment of dyslipidemia.

Dr. Tuan explained that early intervention, maintaining stable lipid reduction, and selecting a personalized regimen not only maximize immediate clinical benefits but also generate long-term value in preventing atherosclerotic events. This serves as the foundation of modern preventive medicine, aiming to improve patient prognosis and extend healthy life expectancy.

One of the highly effective solutions for lowering LDL-C is the combination of statins (the most common lipid-lowering drug class) and Inclisiran (a PCSK9 inhibitor). Inclisiran utilizes small interfering RNA (siRNA) technology to reduce cholesterol production in the liver. Research indicates that Inclisiran significantly lowers the composite rate of major adverse cardiovascular events (MACE) by 25%. Specifically, this medication offers rapid LDL-C reduction, potent and sustained efficacy, and a simplified dosing schedule that supports long-term adherence, while remaining safe when combined with and/or replacing statins.

Dr. Ta Phuong Dung, Deputy Director of the Urology – Nephrology – Andrology Center at Tam Anh General Hospital, HCMC, engages in medical discussions with colleagues during the seminar.

“To optimize cardiovascular risk control and enhance treatment outcomes for patients, it is vital to employ combination therapy to achieve ‘effective and sustainable’ LDL-C targets, thereby preventing the progression or recurrence of cardiovascular events,” Prof. Vo Thanh Nhan concluded.

Experts at the seminar agreed that the management of dyslipidemia is shifting from a “one-size-fits-all” approach toward personalized treatment based on cardiovascular risk, disease characteristics, and individual patient response. The integration of novel therapies with appropriate drug combination strategies is expected to elevate the effectiveness of cardiovascular event prevention and extend healthy lifespans for patients.