The Curbsiders Internal Medicine Podcast #508: ASCVD Risk & Lipids Update! PREVENT, ApoB, Lp(a) + Next-Gen Therapies
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Dec 15, 2025 Dr. Laurence Sperling, a leading preventive cardiologist and former director at Emory's Heart Disease Prevention Center, dives into cutting-edge advancements in ASCVD risk assessment. He introduces the innovative PREVENT risk calculator and discusses its significance in modern lipid management. The conversation highlights the importance of interpreting ApoB and Lp(a), the role of lifestyle changes, and how next-gen therapies could revolutionize treatment. Sperling also covers familial hypercholesterolemia and the strategic use of statins to enhance patient outcomes.
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CPR Framework For ASCVD Risk
- Use the CPR rubric: Calculate risk, Personalize with risk enhancers, then Reclassify when needed.
- Start patient-partnered discussions early and treat risk assessment as the beginning of care.
Calculate Non‑HDL — It's Free
- Always calculate non-HDL cholesterol (total minus HDL) from a standard lipid panel because it costs nothing and captures all atherogenic particles.
- Use non-HDL as a secondary target after LDL, especially when triglycerides are elevated.
When To Use Coronary Calcium Scoring
- Use a non-contrast coronary artery calcium (CAC) CT to reclassify risk when it would change decision-making.
- Explain that a CAC of zero lowers near-term risk but does not exclude atherosclerosis and discuss lifetime risk.