# Nieuwe VA/DoD-richtlijn lipidenmanagement: Lp(a)-screening, CAC-scans en intensievere statinatherapie

*geplaatst 2026-09-23 · Cholesterol · Annals of internal medicine · doi 10.7326/ANNALS-26-01374 · https://hartvaat.nl/2026/09/15/nieuwe-va-dod-richtlijn-lipidenmanagement-lp-a-screening-cac-scans-en-intensieve/*

De 2025-richtlijn van de Amerikaanse VA/DoD voor lipidenmanagement introduceert nieuwe strategieën voor cardiovasculair risicobeoordeling, waaronder de PREVENT-calculator, eenmalige Lp(a)-bepaling en coronair calciumscannen bij klinische onzekerheid. Voor primair en secundair preventieadvies wordt de nadruk gelegd op matig-intensieve statines bij gemiddeld tot hoog risico, en op combinatiebehandeling met statines plus ezetimibe of PCSK9-remmers bij zeer hoog risico. De richtlijn schaft routinele lipideducatie af en adviseert statines voor patiënten met hiv, ongeacht hun 10-jaarsrisico. Deze updates bieden huisartsen en cardiologen een gestructureerd kader voor risicofactoren en intensivering van lipidendaling.

## English: A Synopsis of the 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for Lipid Management for Cardiovascular Disease Risk Reduction.

The 2025 VA/DoD clinical practice guideline on lipid management introduces updated cardiovascular risk assessment tools, including the PREVENT calculator, one-time lipoprotein(a) testing, and coronary artery calcium scoring for risk refinement. It recommends moderate-intensity statins for primary prevention in intermediate-to-high risk patients and HIV-positive adults, while advocating combination therapy with statins plus ezetimibe or PCSK9 inhibitors for very high-risk secondary prevention. Routine lipid monitoring is no longer advised, and the guideline provides clear alternatives for statin intolerance. These updates offer a practical, evidence-based framework for primary care physicians and cardiologists to optimize lipid-lowering strategies.

## Abstract (original, from the publication)

DESCRIPTION: In December 2025, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) released a clinical practice guideline (CPG) update on lipid management for cardiovascular disease risk reduction in adults. This synopsis reviews the 2025 updates and describes the major recommendations. METHODS: The VA/DoD guideline development team updated the 2020 VA/DoD lipid management CPG with clinical stakeholders. The guideline panel developed 12 key questions, systematically evaluated the literature (English-language publications from 16 May 2019 to 15 January 2025), and developed 24 evidence-based recommendations. The recommendations were graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. RECOMMENDATIONS: This synopsis highlights key recommendations for lipid management that are new or differ from other guideline recommendations. This update recommends the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator for risk estimation in primary prevention and removes a previous recommendation against routine lipid monitoring. Two new risk refinement strategies were added: Coronary artery calcium testing is suggested for patients with clinical uncertainty and intermediate-to-high calculated risk, and one-time lipoprotein(a) testing is recommended to identify patients with enhanced cardiovascular risk. For primary prevention, moderate-intensity statins remain the recommended treatment for those at higher risk and should be considered for those at intermediate risk. A new recommendation suggests moderate-intensity statins for adults living with HIV even when 10-year risk is low. This update shifts toward more intensive lipid-lowering therapy for secondary prevention. For very high-risk patients with atherosclerotic cardiovascular disease, the guideline now suggests combination therapy with high-intensity or maximally tolerated statins plus ezetimibe and/or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. For statin-intolerant patients, alternatives include bempedoic acid, ezetimibe, fibrates, or PCSK9 monoclonal antibody inhibitors.

Auteurs: Michael J Arnold, Lance Spacek, Kelvin N V Bush, Ashley Arana Waring, Jennifer Ballard-Hernandez, Darrick Beckman, Catherine Kelley, Sundar Natarajan, Brian E Neubauer, Edward M Phillips, Sophie Roberts, James Sall, Colleen Walsh-Irwin, Paul Heidenreich

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Bron: Annals of internal medicine, https://doi.org/10.7326/ANNALS-26-01374. Bijgewerkt 2026-09-16T01:36:43Z. 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.