New AACE 2025 Dyslipidemia Management Guidelines Released – Top 7 Takeaways

Ohio: The 2025 American Association of Clinical Endocrinology (AACE) guidelines offer evidence-based recommendations for the pharmacologic management of dyslipidemia in adults, emphasizing the role of non-statin therapies in improving atherosclerotic cardiovascular disease outcomes.

Published in Endocrine Practice, the updated guidelines adopt a patient-centered approach, integrating individual preferences, values, treatment acceptability, and healthcare equity into decision-making.

Here are 10 essential insights from the latest clinical practice guidelines on dyslipidemia management:

1. Updated Focus

The 2025 guideline is a focused update to the 2017 American Association of Clinical Endocrinology (AACE) guidelines, providing evidence-based recommendations for the pharmacologic management of dyslipidemia in adults. It emphasizes non-statin pharmacotherapies and their impact on atherosclerotic cardiovascular disease (ASCVD) outcomes.

2. LDL-C Target <70 mg/dl in ASCVD, or high-risk for ASCVD

In adults undergoing pharmacotherapy for dyslipidemia who have ASCVD or are at increased risk for ASCVD, AACE suggests for treatment to an LDL-C target of <70 mg/dL. (Conditional recommendation, low certainty of evidence)

The 2017 recommendation for lower LDL-C treatment targets (<55 mg/dL) was informed by a single trial on statin plus ezetimibe. Subsequent meta-analyses of numerous trials and multiple types of agents did not show a difference in cardiovascular events or mortality.

3. Consider PCSK9 Inhibitors (Alirocumab and Evolocumab) Appropriately

AACE suggests the use of evolocumab or alirocumab for adults with dyslipidemia on maximally tolerated statins who have ASCVD or are at increased risk for ASCVD but are not at the target LDL-C level of <70 mg/dL. This is a conditional recommendation with moderate certainty of evidence.

AACE suggests against using evolocumab or alirocumab in adults with dyslipidemia who do not have ASCVD and who may tolerate other lipid-lowering medications. This is also a conditional recommendation with moderate certainty of evidence.

These drugs are approved by the FDA for adults with established CVD and primary hyperlipidemia, including heterozygous familial hypercholesterolemia(HeFH) and homozygous familial hypercholesterolemia (HoFH), to reduce LDL-C.

4. Consider Bempedoic Acid in Specific Scenarios

AACE suggests using bempedoic acid in addition to usual care for statin-intolerant adults with dyslipidemia who have ASCVD or are at increased risk. This is a conditional recommendation with moderate certainty.

AACE suggests against using bempedoic acid in adults with dyslipidemia who do not have ASCVD and who may tolerate other lipid-lowering medications.

Patients should be informed about potential harms such as gout, cholelithiasis, and tendon rupture, necessitating a shared decision-making approach.

5. Inclisiran Loses Favor

There is currently insufficient evidence to recommend for or against the use of inclisiran in adults with dyslipidemia. Longer-term studies are needed to understand its impact on cardiovascular events and mortality.

6. Eicosapentaenoic Acid (EPA), Icosapent Ethyl (IPE) In, Eicosapentaenoic Acid (EPA) + Docosa- hexaenoic Acid (DHA) Out

For adults with hypertriglyceridemia (150-499 mg/dL) who have cardiovascular disease or are at increased risk, AACE suggests using EPA (Icosapent Ethyl) in addition to statins. This is a conditional recommendation with low certainty of evidence.

There is insufficient evidence to recommend for or against the use of EPA (IPE) in adults with severe hypertriglyceridemia (≥500 mg/dL).

AACE suggests against the use of EPA plus DHA in addition to statin therapy for adults with hypertriglyceridemia (150-499mg/dL) who have cardiovascular disease or are at increased risk. This is a conditional recommendation with low certainty of evidence.

There is insufficient evidence to recommend for or against the use of EPA plus DHA in adults with severe hypertriglyceridemia (≥500 mg/dL).

7. Niacin – Not enough Evidence Yet

AACE recommends against the use of niacin in addition to usual care for adults with hypertriglyceridemia (150-499 mg/dL) who have ASCVD or are at increased risk. This is a strong recommendation with low certainty of evidence.

There is insufficient evidence to recommend for or against the use of niacin in adults with severe hypertriglyceridemia (≥500 mg/dL). Niacin did not provide substantial reductions in CV events but did result in an increased risk of treatment discontinuation.

In summary, the 2025 AACE dyslipidemia guidelines provide updated, evidence-based recommendations for lipid management, prioritizing a patient-centered approach and shared decision-making. Notable updates include an increased emphasis on non-statin therapies, refined guidance on PCSK9 inhibitors and bempedoic acid based on ASCVD risk, and caution regarding the use of EPA plus DHA and niacin. While comprehensive risk assessment remains fundamental, the guidelines underscore the need for further research, particularly on inclisiran and optimal strategies for managing severe hypertriglyceridemia.

Reference:

Patel SB, Wyne KL, Afreen S, Belalcazar LM, Bird MD, Coles S, Marrs JC, Peng CC, Pulipati VP, Sultan S, Zilbermint M. American Association of Clinical Endocrinology Clinical Practice Guideline on Pharmacologic Management of Adults With Dyslipidemia. Endocr Pract. 2025 Feb;31(2):236-262. doi: 10.1016/j.eprac.2024.09.016. PMID: 39919851.