A synopsis in Annals of Internal Medicine summarises the December 2025 update of the US Department of Veterans Affairs and Department of Defense lipid guideline. The panel posed 12 key questions, reviewed literature to January 2025 and made 24 recommendations graded with GRADE.

The update recommends the PREVENT calculator for primary-prevention risk estimation. It removes an earlier recommendation against routine lipid monitoring. Coronary artery calcium testing is suggested where risk is uncertain and calculated risk is intermediate to high, and a one-time lipoprotein(a) measurement is recommended to identify enhanced risk. Moderate-intensity statins stay the treatment for higher-risk primary prevention and should be considered at intermediate risk, with a new suggestion of a moderate-intensity statin for adults with HIV even at low calculated risk.

For secondary prevention in very-high-risk patients, the guideline suggests high-intensity or maximally tolerated statin plus ezetimibe and/or a PCSK9 inhibitor; for statin-intolerant patients, alternatives include bempedoic acid, ezetimibe, fibrates or a PCSK9 antibody. This is a US federal-health-system guideline, and other guidelines, including Indian ones, have not necessarily changed. Risk calculators validated in US populations may not suit South Asian patients, and lipoprotein(a) testing and PCSK9 inhibitors may be limited by cost and access.

Consider a one-time lipoprotein(a) measurement in patients where it would change risk assessment or discussion.
Consider coronary calcium scoring when calculated risk is intermediate to high and the decision to treat is uncertain.
Note that PREVENT is validated in US populations; interpret estimates cautiously in South Asian patients.
In very-high-risk secondary prevention, review whether statin intensity and add-on therapy have been optimised.
Check which guideline your institution follows before changing practice.

Why it matters

It shows a guideline moving from risk scores alone towards refining risk with lipoprotein(a) and calcium scoring.

Don't overread it

This is one US guideline and its synopsis; it does not replace other major guidelines, and the abstract gives no trial data for individual recommendations.