VA/DoD lipid guideline adds a one-time Lp(a) test and combination therapy for very high risk

The edition in brief

The 2025 VA/DoD lipid guideline, summarised in Annals, recommends the PREVENT calculator for primary prevention risk, one-time lipoprotein(a) testing, coronary artery calcium scoring where risk is intermediate to high and uncertain, moderate-intensity statins for adults with HIV even at low calculated risk, and combination therapy with ezetimibe and/or a PCSK9 inhibitor for very high-risk patients with atherosclerotic disease. In MUTTON-HF, 206 Navajo adults with heart failure and a recent admission or ED visit were randomised to 8 weeks of culturally and medically tailored meals or usual dietary advice; all-cause hospitalisation or ED visit at 90 days fell from 57.0% to 40.6% (RR 0.72). A Bayesian network meta-analysis of randomised trials found no reliable benefit on mortality or ICU transfer from rule-based alerts, predictive-model alerts or continuous monitoring on general wards, with very low confidence in all estimates. An international Delphi consensus on POTS and dysautonomia reached over 90% agreement on 31 statements, including recognising patients with orthostatic intolerance who fall short of the heart rate threshold.