Episode Overview

Podcast: AACE Podcasts
Episode: 70: 2025 Algorithm for Management of Adults with Dyslipidemia Update Overview
Date: October 20, 2025
Host: Dr. David Lieb
Guests: Dr. Shailendra Patel (Chair), Dr. Maria Bilalcazar (Vice Chair), Dr. Robert Hegeli (Author, Canadian Cardiovascular Society)

This episode delves into the newly released 2025 AACE Algorithm for the Management of Adults with Dyslipidemia, an international, multidisciplinary update building upon the 2020 algorithm and the January 2025 clinical practice guideline. The discussion covers the motivation for the update, key innovations (including guidance for special populations and new therapies), practical points for clinicians, gaps in knowledge, and emerging treatments.

Key Discussion Points & Insights

1. Background and Motivation for the Update

• International Collaboration:
  The update was developed with contributions from international experts representing North America, Latin America, and Europe, ensuring global relevance.

  • Dr. Patel calls out contributors from Venezuela, Europe, Mexico, California, and Canada.
  • "Like any good chairs, what you do is you surround yourself with absolutely amazing people who are experts." — Dr. Patel [02:41]

• Why Update?

  • Advances in clinical science and more rigorous evidence demand periodic updates.
  • Modern algorithms must translate evolving research into immediately applicable, practical tools for clinicians.
  • Dr. Patel: "We are now entering a different level of sophistication in clinical science... Our updated guidelines... are now beginning to use new tools to evaluate the science base." [07:34]

2. What’s New in the 2025 Algorithm?

• Design and Usability:

  • Improved graphics: "Easy to read, colorful, updated evidence-based slides." — Dr. Bilalcazar [10:13]
  • Concise narratives support figures for clarity and rationale.
  • Retains an intuitive, figure-driven structure for fast reference.

• Content Innovations:

  • Patient-Centered, Risk-Based Approach: The algorithm places renewed emphasis on shared decision-making, health equity, and individualized care.
    • "The 2025 version places a greater emphasis on shared decision making, health equity, individualized care." — Dr. Bilalcazar [10:32]
  • Enhanced Hypertriglyceridemia Guidance:
    • Specific dietary and pharmacological approaches, stratified by severity.
    • "The use of fibrates is limited to certain patients with severe hypertriglyceridemia for prevention of pancreatitis and niacin is no longer recommended." — Dr. Bilalcazar [11:00]
  • Primer on Special Populations:
    • New, easily accessible slides and narrative guidance for groups such as people with HIV, pregnant patients, childhood cancer survivors, older adults, transplant patients, and those receiving gender-affirming care.
    • "Adults receiving gender affirming care... has major impact potentially on lipid metabolism." — Dr. Hegeli [14:19]
  • Genetic Dyslipidemia:
    • Updated logic for assessing genetic forms by primary lipid disturbance, not outdated Fredrickson classification.
    • "We just sort of start, okay, what's the primary lipid disturbance?... And then very logically... the causal genes." — Dr. Hegeli [14:47]

3. How to Apply the Algorithm in Practice

• Keep the Patient at the Center:
  • Assess therapeutic goals, patient context (cultural, economic), and clinical priorities.
  • "If you keep it simple and say what's important to the patient, that's very important." — Dr. Patel [16:59]
• Education and Workflow Integration:
  • Algorithm is ideal for teaching trainees and patients alike due to visual clarity and logical flow.
  • "I could see it being applied at the point of care... Just, you know, essentially, you know, the PowerPoint landscape format onto the screen... very simple flow and logical." — Dr. Hegeli [20:04]
• Beyond Statins:
  • Expands focus to non-statin options and recognizes the needs of diverse patient groups often under-treated or overlooked.
  • "Lipid management goes beyond statins and... there are many patients... we don't even think that they need... a lipid medication." — Dr. Bilalcazar [19:00]

4. Gaps in Evidence and Research Needs

• Outcome Data:
  • Some new drugs (e.g., inclisiran) still lack outcome data—most evidence is for LDL reduction, but not clinical endpoints yet.
  • "We show that it significantly reduces LDL cholesterol, but we really don't have the cardiovascular outcome data yet." — Dr. Bilalcazar [21:57]
• Excluded Populations:
  • More research is desperately needed for groups often left out of trials: severe hypertriglyceridemia, pregnant patients.
• Access Barriers:
  • High prices of new lipid medications remain a critical challenge for patients.

5. Emerging Therapies in Lipid Management

• RNA-Directed Therapies for Triglycerides:
  • Olisarosen (antisense oligonucleotide) and Fosaceran (siRNA) target APOC3, with olisarosen already available for severe forms.
  • These fill urgent gaps for familial chylomicronemia and refractory severe hypertriglyceridemia.
  • "These drugs have been extremely promising... olazarcin is already available and it has a place for severe hypertriglyceridemia." — Dr. Hegeli [24:00]
• Lp(a)-Lowering Agents:
  • In development, but clinical outcome data are pending and needed before routine adoption.
  • "I've always been a little bit circumspect about LP for my whole career... show me the outcome trial." — Dr. Hegeli [25:04]

Memorable Moments & Notable Quotes

• On International Collaboration:
  "We ended up getting the Europeans and the Latin Americans to participate, which I think is just amazing. And that improves our ability to say that when we give this advice it applies to everyone and it will last a little longer." — Dr. Patel [08:51]

• Algorithm as a Practical Tool:
  "You don't need in depth training to be able to read something that's simple. We started this process and I hope that next time someone revives it, they can actually build on some of these concepts so that they can make it better too." — Dr. Patel [18:31]

• On the Need for Access:
  "The lack of access to the new lipid medications, you know, that we face with many of our patients because they're so expensive." — Dr. Bilalcazar [22:40]

• On Specialty and Patient Education:
  "I also think it's important that we share it with our trainees. Like you mentioned, this is a great learning tool for students, for residents, for fellows, for sure." — Dr. Bilalcazar [19:22]

Timestamps for Key Segments

| Time | Segment Description | |---------|------------------------------------------------------------------------------| | 00:28 | Introductions and panelist backgrounds | | 06:39 | Rationale for updating the algorithm | | 10:04 | What's new and improved in the 2025 algorithm | | 12:51 | Special populations addressed in the update | | 16:45 | Key practical points for clinicians | | 21:46 | Gaps in knowledge and areas needing further research | | 23:13 | Next-generation lipid-lowering therapies |

Conclusion

The 2025 AACE Algorithm for Dyslipidemia is a globally informed, visually engaging, and highly practical resource that has evolved to address clinician and patient needs with contemporary science. It stands out by emphasizing health equity, special populations, genetic lipid disorders, and arriving therapies while highlighting ongoing research gaps and challenges in drug access. The episode demonstrates the algorithm’s value as a next-generation point-of-care tool that is as useful for teaching as it is for direct patient management.

To access the full algorithm:
Visit pro.aace.com/clinical-guidance