Why the study?
General-population cholesterol guidelines feature recommendations and risk calculators that do not reliably estimate cardiovascular risk or require important caveats when applied to athletes.
This commentary highlights the need to reconcile general-population dyslipidemia guidelines with athlete-specific caveats, proposing a tailored five-step clinical framework for risk stratification and management in athletes.
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Changes lipid management for athletes >35 to curb CAD-related sudden death; extends prior guidelines with PREVENT equations and universal Lp(a) screening.
Coronary artery disease (CAD) is the leading cause of exercise-related sudden cardiac death in athletes older than 35 years, and dyslipidemia is one of its principal modifiable drivers. The 2026 ACC/AHA/Multisociety Guideline on the Management of Blood Cholesterol introduces several advances directly relevant to athletes, including restored LDL-C treatment targets, universal lipoprotein(a) [Lp(a)] measurement, the PREVENT-ASCVD risk equations, expanded options for selective coronary artery calcium (CAC) scoring, and a more aggressive approach to lipid-lowering therapy (LLT). However, sports cardiology guidelines and consensus statements offer important caveats that must be reconciled with these general-population recommendations: existing risk calculators, including PREVENT, do not reliably estimate cardiovascular risk in athletes, and routine CAC scoring is not recommended in athletes at low calculated risk. This commentary compares and contrasts general-population dyslipidemia recommendations with athlete-specific guidance from contemporary sports cardiology consensus documents, highlights recent evidence on Lp(a), wearable-derived training load, and risk score performance across the physical activity spectrum, and proposes a five-step clinical framework, refined to reflect athlete-specific risk stratification, for dyslipidemia evaluation and management in this population.
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Garba et al. (2026) studied this question.
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