# Lipidenzorg bij ASCVD-preventie: CAC-scoren, Lp(a) en niet-statine-remmers

*geplaatst 2026-08-29 · Cholesterol · Cardiology and therapy · doi 10.1007/s40119-026-00473-5 · https://hartvaat.nl/2026/08/22/lipidenzorg-bij-ascvd-preventie-cac-scoren-lp-a-en-niet-statine-remmers/*

Deze overzichtsstudie belicht de evolutie in de lipidenzorg voor de preventie van atherosclerotische cardiovasculaire ziekte (ASCVD). Naast traditionele risicoschatting worden nu lifetime risk, lipoproteïne(a), apolipoproteïne B en coronaire calciumscore (CAC) ingezet om residuair risico te identificeren en beslissingen bij grenswaarden te sturen. Hoewel statines de basis blijven, benadrukken recente ACC/AHA- en ESC/EAS-richtlijnen vroege intensificatie en de toevoeging van niet-statine-remmers. Deze update biedt een praktisch kader voor cardiologen, internisten en huisartsen om de moderne lipidenzorg in de dagpraktijk toe te passen.

## English: Beyond LDL-C: Modern Lipid Management for ASCVD Prevention in Primary Care.

This narrative review outlines the evolving landscape of lipid management for atherosclerotic cardiovascular disease (ASCVD) prevention in primary care and cardiology. Beyond traditional risk scores, clinicians are increasingly using lifetime risk assessment, lipoprotein(a), apolipoprotein B, and coronary artery calcification (CAC) scoring to identify residual risk and guide therapy. While statins remain foundational, recent ACC/AHA and ESC/EAS guidelines emphasize early treatment intensification and the strategic use of non-statin agents. The article provides a practical, guideline-aligned framework for optimizing secondary and primary prevention strategies.

## Abstract (original, from the publication)

Prevention of atherosclerotic cardiovascular disease (ASCVD) is fundamental for both cardiologists and primary care physicians. From risk estimation to medical therapy for primary and secondary prevention, management is evolving with increasing evidence. Risk estimation is moving toward a model that emphasizes lifetime risk in addition to traditional shorter-term risk and takes a holistic view of individual patient cardiovascular risk, accounting for genetic predisposition and risk-enhancing comorbid conditions. Lipoprotein(a) and apolipoprotein B measurement and coronary artery calcification (CAC) scoring have emerged as tools for identifying residual risk and making decisions in cases of borderline risk. While statins remain foundational to management, newer treatment paradigms emphasize early intensification of therapy and addition of non-statin agents. These trends are reflected in recent guideline updates from the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS). In the future, polygenic risk scoring and RNA-based therapies may offer opportunities to identify and treat those at highest residual risk.

Auteurs: Andrew Carlson, Zaid A Zayyad, Stefanie Driesenga, Peter Boxley, Atreya Mishra, Omar Uraizee, Rediat Ephrem, Runze Zhang, Zachary Natsheh, Adhir R Shroff

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Bron: Cardiology and therapy, https://doi.org/10.1007/s40119-026-00473-5. Bijgewerkt 2026-08-23T00:52:38Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.