Understanding the Current State of LDL-C Goal Attainment and Barriers to Adequate Control in Hyperlipidemia

Panelists discuss how the LDL-C crisis continues to represent a major unmet need in cardiovascular care. Despite effective therapies and decades of guideline development, too many patients remain undertreated, often due to clinical inertia, patient apathy, and systemic barriers. The conversation highlights how social determinants of health exacerbate these issues, and how real-world data show widespread gaps between what should be achieved and what is actually occurring in practice.

Panelists discuss how the 2013 cholesterol guideline shift away from LDL-C target goals reshaped clinical practice and quality metrics. By replacing outcome-focused goals with statin-use measures, unintended consequences arose—such as reduced focus on achieving optimal LDL levels. The panel explores whether reinstating targets could better align incentives, reduce variability across systems, and re-establish LDL-C control as a priority. International guidelines that emphasize aggressive LDL goals are also examined for their potential influence on U.S. practice.

Panelists discuss how therapy access, adherence, and cost remain persistent challenges. Statins remain the foundation of treatment, but underuse of add-on therapies, including PCSK9 inhibitors, continues due to payer restrictions, administrative hurdles, and patient nonadherence. Looking forward, new therapies such as oral PCSK9 inhibitors may help overcome barriers. The discussion closes with recognition of the economic burden of prolonged high LDL-C exposure, the importance of workplace wellness programs, and the opportunity for employers and health systems to integrate cholesterol management into broader prevention strategies.