2026, Volume 33, Supplement 2: Atherosclerosis starts in childhood – a practical guide to improve its outcomes through lipid management in primary care

Atherosclerotic cardiovascular disease (ASCVD) is the most common cause of death and disability worldwide, and dyslipidaemia is a primary and treatable risk factor for the disease. Despite widespread availability and use of lipid-lowering medications, poor health outcomes and reduced quality of life due to ASCVD remain major unmet needs within the UK. Guidelines from the National Institute for Health and Care Excellence (NICE) aim to support identification of high-risk individuals and to optimise management so that fewer people experience acute cardiovascular (CV) events, such as myocardial infarction or stroke, or develop peripheral vascular disease. ASCVD development may begin in childhood and many people experience onset of vascular disease or events despite having cholesterol levels beneath the thresholds defined by NICE for initiation of lipid-lowering therapy. Clinical guidelines tend to favour sequential introduction of medications (usually beginning with statin monotherapy) although combination therapy (from the start of treatment) may provide improvements in long-term CV protection, as demonstrated in other disease areas (e.g., hypertension, type 2 diabetes mellitus). European and international recommendations provide more stringent thresholds that are based upon low-density lipoprotein cholesterol (LDL-C) concentration, rather than the non-high-density lipoprotein cholesterol measures stipulated by NICE; lower LDL-C levels are aimed for as CV risk rises. This article reviews current understanding concerning the mechanisms believed to underpin development of ASCVD, guideline recommendations for management of disease and the evidence supporting more robust therapeutic approaches to lipid lowering. Finally, recommendations are made to support healthcare professionals in improving lipid management, with a treatment algorithm more closely aligned to European guidelines and a range of quick reference resources provided to help guide empowering conversations with patients regarding the importance of lipid lowering for lifetime risk management....