{"id":"16341f39540b","type":"article","url":"https://hartvaat.nl/2026/09/01/afstand-tot-ldl-doelwaarde-stuurt-keuze-lipiddalende-therapie/","title":"Afstand tot LDL-doelwaarde stuurt keuze lipiddalende therapie","title_en":"LDL-cholesterol distance to target: A practical tool for guiding lipid-lowering treatment decisions","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["esc-2026"],"journal":"Atherosclerosis plus","doi":"10.1016/j.athplu.2026.100574","source_url":"https://doi.org/10.1016/j.athplu.2026.100574","authors":["Maria Chiara Palloni","Teresa Farella","Andrea Faggiano","Marco Vatri","Francesco Fattirolli","Elisabetta Angelino","Marco Ambrosetti","Massimiliano Ruscica","Alberto Corsini","Stefano Carugo","Andrea Poli","Pompilio Faggiano"],"significance":5,"published":"2026-07-26","source_date":"2026-09-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/esc-richtlijn-dyslipidemie-2019/","https://hartvaat.nl/kennis/lipiden/lipidenverlaging-stappenplan/"],"congress":"esc-2026","summary_en":"This practical review proposes calculating the 'distance to target'—the percentage reduction in LDL-C required from baseline—as a streamlined tool for selecting lipid-lowering therapy in patients with atherosclerotic cardiovascular disease. Despite stringent 2025 ESC/EAS guidelines and strong evidence linking cumulative LDL exposure to cardiovascular risk, less than one-third of secondary prevention patients achieve target levels due to therapeutic inertia. By aligning the expected efficacy of available agents (statins, ezetimibe, bempedoic acid, PCSK9 inhibitors, inclisiran) with individual patient needs, this framework helps clinicians overcome treatment gaps and optimize early, intensive lipid lowering.","created":"2026-07-04T15:38:44Z","updated":"2026-08-10T11:07:51Z","licence":"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.","body_markdown":"Deze praktische review bespreekt hoe de 'afstand tot het LDL-doelwaarde' (berekenbaar als percentage daling vanaf de baseline) kan helpen bij het kiezen van de juiste lipiddalende therapie, vooral bij patiënten met een hoog of zeer hoog cardiovasculair risico. Ondanks de strengere ESC/EAS-richtlijnen van 2025 en het bewijs dat cumulatieve LDL-blootstelling cruciaal is, haalt minder dan een derde van de patiënten in secundaire preventie het streefdoel door therapeutische inertie. Het voorgestelde rekenmodel stelt clinici in staat om direct te bepalen of monotherapie met een statine volstaat of dat combinaties met ezetimibe, bempedoïnezuur, PCSK9-remmers of inclisiran nodig zijn. Dit kan de therapeutische inertie doorbreken en de LDL-controle in de dagpraktijk verbeteren.","abstract_original":"Low-density lipoprotein cholesterol (LDL-C) is causal in atherosclerotic cardiovascular disease (ASCVD), still the leading causes of global morbidity and mortality. The 2025 update of the ESC/EAS guidelines for the management of dyslipidemia recommends increasingly stringent, risk-based LDL-C targets. Beyond achieved LDL-C targets, cumulative exposure over time has emerged as a key determinant of ASCVD risk. Accordingly, treatment strategies should evolve from a traditional stepwise approach toward a more proactive, personalized, and target-oriented model; the recognized impact of cumulative LDL-C exposure further reinforces the importance of early, intensive, and sustained lipid lowering therapies (LLT). Despite this awareness and the availability of effective therapies, LDL-C control in clinical practice remains suboptimal. This gap is largely driven by the so called \"therapeutic inertia\", involving physician-related factors, patient barriers, and healthcare system constraints; accordingly, fewer than one-third of patients in secondary prevention achieve recommended LDL-C goals. A significant improvement in this situation requires structured treatment algorithms, multidisciplinary care, improved patient education, and integration of digital decision-support tools. A pragmatic framework to improve goal attainment is the estimation of \"distance to target\", which enables selection of LLT based on the required percentage reduction from baseline LDL-C levels. This approach facilitates alignment between the expected efficacy of available treatments and individual patient needs. While statins remain first-line therapy, combination regimens are frequently required-particularly in very high-risk patients-including ezetimibe, bempedoic acid, PCSK9 inhibitors, and inclisiran."}