From Registry Evidence to Innovation: New Horizons in LDL-C Management
CME Unit: 0.5/1 point | 
1 hour | 
01 Apr 2027
Overview
About this course
Atherosclerotic cardiovascular disease (ASCVD) remains a leading global cause of morbidity and mortality, with low-density lipoprotein cholesterol (LDL-C) established as a causal driver of atherosclerosis. The 2025 Focused Update of the 2019 ESC/EAS Dyslipidaemia Guidelines reinforces intensive, individualized LDL-C lowering based on total cardiovascular (CV) risk and clarifies earlier use of combination lipid-lowering therapy (LLT). Updated risk assessment tools—SCORE2 and SCORE2-OP—improve estimation of fatal and non-fatal CV events in adults aged 40–89 years and incorporate modifiers such as lipoprotein(a), family history, and comorbidities, ensuring more accurate treatment stratification.
Statins remain first-line therapy, but the updated algorithm more clearly integrates non-statin agents, particularly bempedoic acid. LDL-C reductions are additive across therapies: high-intensity statins (~50%), ezetimibe (~20%), and bempedoic acid (~20%), with dual and triple combinations achieving up to ~70% reduction. Non-statin therapies with proven CV benefit—including ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and bempedoic acid—receive strong recommendations, especially for statin-intolerant patients and those not reaching LDL-C targets.
Bempedoic acid, an adenosine triphosphate (ATP)-citrate lyase inhibitor activated in the liver, offers effective LDL-C lowering with favorable tolerability and minimal myalgia risk. Evidence supports the effectiveness of bempedoic acid—alone or with ezetimibe—in improving LDL-C goal attainment, particularly in high- and very-high-risk patients.
Despite clearer guidance, real-world data demonstrate persistent LDL-C target underachievement due to risk underestimation and underuse of combination therapy. The 2025 update emphasizes earlier, structured combination therapy to close LDL-C treatment gaps and improve long-term cardiovascular outcomes. Emerging therapies, including oral CETP and PCSK9 inhibitors and Lp(a)-lowering agents, may further reduce residual risk.
This CME aims to equip clinicians with a comprehensive understanding of current best practices and upcoming innovations to close the LDL-C treatment gap and improve ASCVD outcomes.
Learning outcomes
Upon completion of this CME activity, participants should be able to:
- Describe the key updates in the 2025 ESC/EAS Focused Update on LDL-C management, including revised treatment sequencing and risk stratification.
- Explain the clinical role of bempedoic acid in both statin-intolerant patients and as part of combination lipid-lowering therapy to achieve LDL-C goals.
- Evaluate current evidence demonstrating the gap in LDL-C target attainment among high-risk and very high-risk patients using real-world registry data.
- Apply optimized treatment strategies using statins and non-statin agents to improve LDL-C goal achievement.
- Discuss emerging LDL-C and Lp(a)-lowering therapies and their potential future impact on ASCVD risk reduction.
Topic covered:
- Refined Risk Estimation: Setting the Stage for Treatment Escalation
- Bempedoic Acid in the Updated LDL-C Treatment Algorithm
- Persistent LDL-C Treatment Gaps and the Need for Combination Therapy
- Real-World Effectiveness of Bempedoic Acid
- Beyond Current Therapy: Emerging Agents on the Horizon
- Conclusion
Speaker for this module:
Prof. Ioanna Gouni-Berthold
Head, Lipid Clinic and Lipid Research Clinic
Centre for Endocrinology, Diabetes and Preventive Medicine
University of Cologne, Germany
0.50/1 CME Point Available
- This journal is accredited for 1 CME Point for medical practitioners enrolled in The Medical Council of Hong Kong’s Continuing Medical Education Programme for Practising Doctors who are not taking CME for Specialists.
- This journal is accredited for both Hong Kong Doctors Union (HKDU) members and non-members.
- This module is accredited for 0.50 CME point for fellows of the Hong Kong College of Community Medicine and the Hong Kong College of Physicians.
- Please note that this module will not earn CME credit for fellows of colleges not listed here.
- A certificate can be downloaded upon successful completion of the quiz. Please use the information on the certificate to claim your CME point.
This CME module is accredited by the Hong Kong Doctors Union (HKDU)
