VA/DoD Update Lipid Guideline, Shift Toward Intensive Secondary Prevention

The VA and DoD released an updated 2025 clinical practice guideline on lipid management for cardiovascular disease risk reduction, replacing the 2020 version with 24 new evidence-based recommendations graded using GRADE methodology. The guideline now recommends the PREVENT calculator for primary prevention risk estimation, removes a prior recommendation against routine lipid monitoring, and adds coronary artery calcium testing for select patients with clinical uncertainty plus one-time lipoprotein(a) testing to identify enhanced cardiovascular risk. For secondary prevention, the guideline shifts toward more intensive therapy, suggesting combination treatment with high-intensity or maximally tolerated statins plus ezetimibe and/or PCSK9 inhibitors for very high-risk atherosclerotic cardiovascular disease patients, and lists bempedoic acid, ezetimibe, fibrates, or PCSK9 monoclonal antibodies as options for statin-intolerant patients; a new recommendation also suggests moderate-intensity statins for adults with HIV even at low calculated 10-year risk.

Most relevant for: Patients with established atherosclerotic cardiovascular disease or very high cardiovascular risk requiring secondary prevention, and adults with HIV at lower calculated cardiovascular risk

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Informational only. Not medical advice. Not a substitute for clinical judgment. Always consult current guidelines and your own clinical judgment.