Atherosclerotic cardiovascular disease (ASCVD) is a disease caused by the accumulation of atherosclerotic plaques that leads to arterial hardening and impairment of contractility. Proprotein convertase subtilisin/kexin type 9 (PCSK9) can increase low-density lipoprotein cholesterol levels in plasma, which accelerates the development and progression of ASCVD. This article intends to review the biological characteristics and functional mechanisms of PCSK9, elucidate its impact on the development and progression of ASCVD, provide research literature support for the diagnosis and treatment of such diseases and improving the prognosis of patients.
The 2026 American College of Cardiology/American Heart Association multisociety guideline on the management of dyslipidemia provides a comprehensive update to the 2018 cholesterol guideline. With the prevention of ASCVD (atherosclerotic cardiovascular disease) as its central goal, the new guideline emphasizes earlier identification, earlier intervention, and long-term management of dyslipidemia to reduce lifetime exposure to atherogenic lipoproteins. The PREVENT-ASCVD equations are recommended to replace the previous Pooled Cohort Equations for 10-year and 30-year cardiovascular risk assessment. Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol treatment goals are re-emphasized in clinical decision-making, and apolipoprotein B and lipoprotein(a) are assigned more important roles in risk refinement. In terms of treatment, statins remain the foundation of lipid-lowering therapy, while the roles of ezetimibe, proproteinconvertase subtilisin/kexin type 9 monoclonal antibodies, bempedoic acid, inclisiran, and apolipoprotein C3 inhibitors are further clarified. This article interprets the background, key updates, primary and secondary prevention strategies, use of special lipid biomarkers, management of hypertriglyceridemia, and positioning of novel lipid-lowering therapies in the 2026 guideline, and discusses their implications for dyslipidemia management in China.
ObjectiveTo interpret the major updates in the "2026 ACC/AHA Guideline on the Management of Dyslipidemia" and provide guidance for perioperative and long-term lipid management in patients undergoing cardiovascular surgery. Methods Based on the 2026 guideline and relevant cardiovascular outcome studies, this article summarized key aspects of lipid management across the entire life span, PREVENT-ASCVD risk assessment, low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) targets, lipoprotein(a) and apolipoprotein B testing, management of hypertriglyceridemia, and the use of non-statin therapies, while analyzing their clinical implications from the perspective of cardiovascular surgery. ResultsThe 2026 guideline expanded the focus of lipid management from simple cholesterol control to comprehensive, lifelong lipid protein risk management across the entire spectrum. It recommended the PREVENT-ASCVD model, integrated risk-enhancing factors and coronary artery calcium scores to refine risk stratification, re-established LDL-C and non-HDL-C targets, strengthened management of lipoprotein(a), apolipoprotein B, and hypertriglyceridemia, and emphasized early combination lipid-lowering therapy. These updates helped identify residual cardiovascular risks in surgical patients, promoted postoperative lipid target achievement, and supported long-term secondary prevention. ConclusionThe 2026 guideline advances lipid management toward precise risk stratification, goal-directed therapy, and longitudinal intervention. Standardized lipid assessment and lipid-lowering therapy should be integrated into perioperative and long-term postoperative management in cardiovascular surgery to improve long-term patient outcomes.