Evolution of LDL-C Testing and Cholesterol Management Guidelines
Manolo U. Rios1, Alan T. Remaley2, Jing Cao1,3,*
1Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
2Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
3Department of Pathology, Children's Health, Dallas, Texas, USA.
Accurate assessment of low-density lipoprotein cholesterol (LDL-C) is central to the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). Recent clinical guidelines have emphasized lower LDL-C targets and the use of non-fasting lipid testing, increasing the need for more reliable LDL-C estimation methods than the traditional Friedewald calculation. The development of modern Martin and Sampson methods has led to improved accuracy across a wider range of LDL-C and triglyceride levels. The most recent Modified Sampson method further enhances performance, particularly at low LDL-C levels. These modern LDL-C methods have been incorporated into up-to-date cholesterol management guidelines, which now recommend modern LDL-C methods over the Friedewald calculation. This review summarizes the evolution of LDL-C testing method and its integration into clinical practice to support more precise ASCVD management.
DOI: 10.29245/2578-3025/2026/3.1251 View / Download PdfCardiac Morbidities in Elite Endurance Athletes: Rare but Potentially Serious
Ritesh Chandrasekaran1*, Amit Sagar1, George R. Luck1, Charles H. Hennekens1
1Florida Atlantic University, Schmidt College of Medicine.
Elite endurance athletes (EEAs) have exceptional physical and mental capabilities. These allow EEAs to perform physical activities at extraordinary levels. Nonetheless, although any medical complications EEAs suffer are very rare, they may develop hypertension, atrial fibrillation, and even coronary heart disease (CHD). In our mini review we consider first the basic research and then the clinical relevance of these very rare but potentially serious complications. After completing our mini review, we conclude that the benefits accrued to EEAs participating in their extremely high levels of daily physical activities, far exceed their rare but potentially serious complications of hypertension, atrial fibrillation and CHD. These findings in EEAs are compatible with those in the general population that indicate the need to achieve higher daily levels of physical activities. In the United States (US), only 21% of individuals achieve even the minimally recommended daily levels of physical activity. These low levels can be achieved even among the oldest old. Thus, physical inactivity in the US seems to be the new “silent killer” replacing hypertension the old “silent killer.”
DOI: 10.29245/2578-3025/2026/3.1241 View / Download PdfCommentary on Digital Health Outreach to Increase Patient Activation and Reduce 30-day Readmissions Following Heart Failure Hospitalizations
Spencer H. Kubo, MD, FACC1
1Chief Medical Officer, CareCognitics, Inc, United States of America
Readmissions after heart failure hospitalizations have been a focus of quality improvement programs for almost 2 decades. The program described in this paper is representative of an emerging theme of continuous remote care and appears to be very effective in reducing readmissions. As these programs are scalable and relatively inexpensive, one can envision tremendous growth potential.
DOI: 10.29245/2578-3025/2026/3.1256 View / Download PdfNon-fasting Remnant Cholesterol as an Independent Risk Factor for Atherosclerotic Vascular Disease
Reihane Taheri1 and Spencer D Proctor1,*
1Metabolic and Cardiovascular Diseases Laboratory, Division of Human Nutrition, University of Alberta, Edmonton, AB T6G 2E1, Canada.
Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, with atherosclerosis as the primary underlying pathophysiology. Dyslipidemia is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD). While low-density lipoprotein cholesterol (LDL-C) has traditionally been considered as the primary atherogenic lipoprotein, growing evidence highlights the importance of non-fasting triglyceride-rich lipoproteins (TRLs) in cardiovascular risk. The premise for atherogenicity of non-fasting TRLs is associated with their relative composition of cholesterol as well as their proinflammatory profile within the arterial extracellular matrix. Non-fasting remnant cholesterol (RC) is representative of the cholesterol content of TRLs in post-prandial state and can include contributions from the very low-density lipoprotein (VLDL) and chylomicron synthesis pathways. Interestingly, while growing evidence has demonstrated that non-fasting RC is a significant independent risk factor for ASCVD (independent of LDL-C levels), clinical guidelines have not yet fully incorporated the adoption of RC assessment. Importantly, lifelong reductions in non-fasting RC exposure may meaningfully reduce ASCVD risk. Consequently, future guidelines may benefit from incorporating non-fasting RC screening and targeted interventions alongside traditional lipid measures.
DOI: 10.29245/2578-3025/2026/3.1253 View / Download PdfWomen with Homozygous Familial Hypercholesterolemia and Impact on Reproductive Life from Menarche to Menopause: Long-Term Case Series Observational Study
Claudia Stefanuttia,*, Giuseppina Perroneb, Giovanna Zeppaa, Valentina Demarcob, Paola Galoppib, Giuseppe Rizzob, Hofit Cohenc, Handrean Sorand and the MIGHTY MEDIC – Multidisciplinary International Group for Hemapheresis Therapy and Metabolic Disorders Control
aDepartment of Molecular Medicine, Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Regional Centre for Rare Diseases, Immunohematology and Transfusion Medicine, Umberto I Hospital, “Sapienza” University of Rome, Viale del Policlinico 155, Rome, 00161, Italy.
bDepartment of Maternal and Child Health and Urological Sciences, Umberto I Hospital, “Sapienza” University of Rome, Viale del Policlinico 155, Rome, 00161, Italy.
cThe Bert W. Strassburger Lipid Center, Sheba Medical Center, Tel-Hashomer, 5265601, Israel; Gray School of Medical Sciences, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Israel.
dNIHR/WELLCOME Trust Clinical Research Facility and Department of Endocrinology, Diabetes and Metabolism, Peter Mount Building, Manchester University Hospital NHS Foundation Trust, M13 9WL, Oxford Road, Manchester, United Kingdom.
Homozygous familial hypercholesterolemia (HoFH) is a genetic disease in which LDL-C is high at birth, causing cardiovascular disease. Reproductive issues in women are also caused by lipid-lowering therapies (LLTs) that must be interrupted during pregnancy and breastfeeding. The only safe choice during pregnancy is lipoprotein apheresis (LA), although there are limited data regarding fertility, pregnancy, and menopause. This long-term case series observational study examined 23 genetically confirmed HoFH women in a tertiary health facility, obtaining clinical, cardiovascular, biochemical, and reproductive information through medical records and structured interviews. Cardiovascular disease and aortic valve disease were found in 48% and 52%, respectively; four women died prematurely. Menarche (12.1 years) and menopause (52.0 years) were in the normal range. The majority of these had regular menstrual cycles; there was one case of polycystic ovary syndrome. Twelve women became spontaneously pregnant. Obstetric complications included preterm delivery, gestational diabetes, hypertension, and fetal growth restriction. This study showed that continuous LA during pregnancy was associated with better lipid control and maternal-fetal outcomes, but cardiovascular impairment was observed in the case of interruption of LLT. LLT interruption affects the inherited lipid disorder, and a very short period of breastfeeding is recommended. HoFH in women under treatment has no impact on the menstrual cycle or on the timing of menopause. Pregnancy is a high-risk condition that needs the care of a multidisciplinary team. The need to ensure continuous LA, systematic reproductive counseling, early cardiovascular examination, and aligned lifelong care is critical in maximizing the outcome of HoFH women.
DOI: 10.29245/2578-3025/2026/3.1250 View / Download PdfArrhythmias in Acute Pulmonary Embolism: Current Evidence and Unresolved Questions
Sara Sóñora-López 1, Nuria Rivas-Gándara 1,2,3, Gerard Oristrell-Santamaria 1,2,3, Ignacio Ferreira-González 1,3,4,5
1Cardiology Department, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
2Biomedical Research Networking Centre on Cardiovascular Diseases (CIBERCV), Barcelona, Spain
3Vall d’Hebron Research Institute (VHIR), Barcelona, Spain
4Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
5Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP), Madrid, Spain
Acute pulmonary embolism (PE) presents with a wide clinical spectrum ranging from asymptomatic cases to obstructive shock and sudden cardiac death. While supraventricular arrhythmias, particularly atrial fibrillation and sinus tachycardia, are well recognized and associated with worse outcomes, ventricular arrhythmias remain poorly defined and are not routinely included in clinical guidelines. Emerging evidence from case reports suggests that ventricular tachycardia (VT), often with a morphology suggestive of a right ventricular origin, may occasionally represent an initial manifestation of acute PE in patients without structural heart disease. Reported cases consistently show resolution of VT following anticoagulation and treatment of PE, supporting the concept of a transient and reversible arrhythmogenic trigger. Proposed mechanisms include acute right ventricular pressure overload, ischemia, sympathetic activation, hypoxemia, and mechanical stimulation. In contrast, syncope and cardiac arrest associated with PE are more commonly linked to non-shockable rhythms reflecting hemodynamic collapse rather than primary ventricular arrhythmia. Despite these observations, the true incidence and prognostic significance of ventricular arrhythmias in PE remain unknown. This narrative review summarizes current evidence, explores potential mechanisms, and discusses diagnostic and therapeutic implications, highlighting the need for further studies to better define this underrecognized clinical association.
DOI: 10.29245/2578-3025/2026/3.1254 View / Download Pdf