The American Association of Clinical Endocrinology (AACE) released a new clinical practice guideline, Pharmacologic Management of Adults with Dyslipidemia, in early 2025. The 2025 clinical practice guideline is a focused update to the 2017 AACE guideline, Management of Dyslipidemia and Prevention of Cardiovascular Disease. The 2025 focused update features 13 recommendations, down from the 87 recommendations from the 2017 guideline.
Today, we are taking a look at how the 2025 and 2017 guidelines compare to one another by examining a selection of key differences between the two.
Guidelines Referenced:
Pharmacologic Management of Adults with Dyslipidemia
Management of Dyslipidemia and Prevention of Cardiovascular Disease
Comparison of Guidelines and Key Takeaways (2017 – 2025)
| Item | 2017 Guideline | 2025 Guideline |
|---|---|---|
| ASCVD Risk Assessment | Evidence suggests that hsCRP may be helpful in predicting coronary events. Measurement of Lp-PLA2, which appears to be more specific than hsCRP, may be helpful when it is necessary to further stratify an individual’s risk for ASCVD, especially in the presence of systemic CRP elevations. | For primary prevention in adults with dyslipidemia, AACE recommends for the use of a validated tool or calculator to predict future risk of ASCVD events as part of shared decision-making around treatment. |
| Monoclonal Antibodies | Alirocumab and evolucumab are subcutaneously injectable LDL-lowering agents capable of further reducing LDL approximately 60% when added to maximum statin therapy. The recently published results of the FOURIER trial demonstrate the efficacy of evolucumab in lowering LDL-C and reducing cardiovascular risk in high-risk individuals receiving high intensity statin therapy. The ODYSSEY OUTCOMES trial is ongoing to determine the efficacy of the alirocumab for the reduction of the same composite cardiovascular events outcome. | In adults with dyslipidemia who are on maximally tolerated statins and have ASCVD or are at increased risk for ASCVD but who are not at goal (LDL-C <70 mg/dL), AACE suggests for the use of evolocumab or alirocumab in addition to usual care. In adults with dyslipidemia who do not have ASCVD and who may tolerate other lipid-lowering medications, AACE suggests against the use of evolocumab or alirocumab in addition to usual care. |
| Bempedoic Acid | Not addressed. | In adults with dyslipidemia who are statin-intolerant and have ASCVD or are at increased risk for ASCVD, AACE suggests for the use of bempedoic acid in addition to usual care. In adults with dyslipidemia who do not have ASCVD and can tolerate other lipid-lowering medications, AACE suggests against the use of bempedoic acid in addition to usual care. |
| Eicosapentanoic Acid and Docosahexanoic Acid | Not addressed. | In adults with hypertriglyceridemia (150-499 mg/dL) who have ASCVD or are at increased risk for ASCVD, AACE suggests for the use of EPA (IPE) in addition to statins. In adults with hypertriglyceridemia (150-499 mg/dL) who have ASCVD or are at increased risk for ASCVD, AACE suggests against the use of EPA plus DHA in addition to statin therapy. |
| Niacin | Niacin therapy is recommended principally as an adjunct for reducing TG. Niacin therapy should not be used in individuals aggressively treated with statin due to absence of additional benefits with well-controlled LDL-C. | In adults with hypertriglyceridemia (150-499 mg/dL) who have ASCVD or are at increased risk for ASCVD, AACE recommends against the use of niacin in addition to usual care. |
| Treatment Goals for Reduction of LDL-C in Persons with Dyslipidemia | For individuals at very high risk (i.e., with established or recent hospitalization for acute coronary syndrome (ACS); coronary, carotid or peripheral vascular disease; diabetes or stage 3 or 4 CKD with 1 or more risk factors; a calculated 10-year risk greater than 20%; or heterozygous familial hypercholesterolemia [HeFH]), an LDL-C goal <70 mg/dL is recommended. | In adults undergoing treatment for dyslipidemia who have ASCVD or are at increased risk for ASCVD, AACE suggests for treatment to an LDL-C target of <70 mg/dL. |
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