Systematic review of clinical guidance for lipid management in adults with or at risk of atherosclerotic cardiovascular disease: a global perspective
Key result
Global lipid guidelines broadly agree on initial statins but diverge widely on LDL-C targets.
- n=109
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Why the study?
Important differences and gaps exist in global clinical guidance on lipid management for adults with or at risk of ASCVD, especially regarding LDL-C goals, non-statin therapies, and specific populations.
Key Points
- Identify global clinical guidance on lipid management in adults at risk of or diagnosed with atherosclerotic cardiovascular disease and summarize recommendations for high-risk populations.
- Searched Embase, MEDLINE, and guideline-specific databases for clinical practice guidelines and expert consensus statements published within the last 10 years.
- Screened records independently with two reviewers, identifying 109 unique guidance documents across major continental regions.
- Extracted recommendations on lipid testing, low-density lipoprotein cholesterol (LDL-C) targets, lifestyle changes, and lipid-lowering therapies, assessing methodological quality via the AGREE II instrument.
- Of the 109 identified documents, 31% originated from Europe/UK, 26% from Asia-Pacific, 23% from the US/Canada, 10% were international, 5% from Latin America, 5% from the Middle East, and <1% from Africa.
- High-risk LDL-C target goals differed markedly by region, with European guidance generally recommending <70 mg/dL or <50-55 mg/dL, whereas Asian-Pacific guidance frequently recommended <100 mg/dL (or <120 mg/dL in Japan).
- Statins were universally recommended as first-line therapy, but guidance differed on non-statin escalation pathways, while dedicated recommendations for older adults, women, and obesity remained sparse.
Study Design
Type
Systematic Review (n=109)
Structured PICO
P
Population
A systematic review of 109 clinical practice guidelines and expert consensus statements published globally between 2014 and 2025 regarding lipid management in adults at risk of or diagnosed with ASCVD.
E
Exposure
Lipid management strategies including lipid testing, LDL-C goals, lifestyle modifications, and lipid-lowering treatments (e.g., statins, ezetimibe, PCSK9 inhibitors, bempedoic acid, bile acid sequestrants).
O
Outcome
Recommendations pertaining to LDL-C testing or goals and the use of pharmacological lipid-lowering therapies.
Global clinical guidelines for lipid management share common foundational recommendations like statin use, but exhibit significant regional variations in specific LDL-C targets and the integration of non-statin therapies.
Limitations
- Clinical guidance published after March 24, 2025 was not eligible for inclusion in the systematic review.
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Implication
Guideline variation in LDL-C targets may drive inconsistent lipid care; challenges assumptions of global consensus and leaves open need for harmonized recommendations.
Abstract
Aims To identify clinical guidance globally on lipid management in adults who are at risk of or diagnosed with atherosclerotic cardiovascular disease (ASCVD) and to summarize recommendations for patients with increasingly prevalent diseases (diabetes, chronic kidney disease, and obesity), older adults, and women. Methods A systematic review of clinical guidance published within the last 10 years was performed by searching Embase, MEDLINE, and guideline-specific databases. Relevant guidance documents were selected by two independent reviewers. Recommendations pertaining to lipid testing, low-density lipoprotein cholesterol (LDL-C) goals, lifestyle modifications, and lipid-lowering treatment were extracted. Results A total of 109 clinical practice guidelines and expert consensus statements were identified, which were international (10%) or developed within Europe or the United Kingdom (31%), Asia-Pacific (26%), the United States or Canada (23%), Latin America (5%), the Middle East (5%), or Africa (<1%). Although clinical guidance provides common recommendations for lipid management in patients at risk of or diagnosed with ASCVD, including patients with diabetes or chronic kidney disease, recommendations concerning LDL-C goals and use of non-statin therapies often differ across guidance documents. Furthermore, recommendations specific to older adults, women, and patients with obesity are sparse. Conclusions Although clinical guidance from around the world provides a common framework for lipid management, important differences remain in recommendations concerning LDL-C goals, use of non-statin therapies, and management of certain patient populations. Future research and guidance development may help address these gaps and improve the consistency and applicability of recommendations across healthcare settings.
IJC CRP · systematic review. Your very-high-risk patient's LDL-C target depends on which guideline you follow. Systematic review of clinical guidance for lipid management in adults with or at risk of atherosclerotic cardiovascular disease: a global perspective 109 guidance documents: Global lipid guidance, systematically reviewed. Guidance sources barely include Africa: Europe/UK 31%, Asia-Pacific 26%, US/Canada 23%, Africa <1%. High-risk LDL-C targets differ by region: Europe <70 or <50-55 mg/dL vs Asia-Pacific <100 mg/dL. Statins agreed, escalation diverges: Statins: universal first-line → Escalation paths differ → Non-statin use varies. Dedicated guidance sparse for these groups: Older adults, Women, Obesity. Bottom line: Varying LDL-C targets may drive inconsistent lipid care worldwide.
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Cite This Study
Akers et al. (2026) conducted a systematic review in Atherosclerotic cardiovascular disease (ASCVD) (n=109). Clinical guidance for lipid management was evaluated on Recommendations pertaining to lipid testing, LDL-C goals, lifestyle modifications, and lipid-lowering treatment. A systematic review of 109 global clinical guidance documents revealed common recommendations for initial statin therapy but substantial variation in LDL-C goals and the use of non-statin therapies.