Mayo Clinic Talks Update in the Management of Hyperlipidemia
Mar 24, 2026
Stephen Kopecky, a preventive cardiologist at the Mayo Clinic, discusses modern hyperlipidemia care. He covers combination therapy to safely lower LDL. He explains lower LDL targets for prevention and disease. He reviews new risk markers, PCSK9 therapies including inclisiran, coronary calcium scoring, Lp(a) testing, triglyceride strategies, and ways to improve adherence.
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How PCSK9 Inhibitors Work Mechanistically
- PCSK9 inhibitors improve hepatic LDL receptor recycling to dramatically lower LDL and work synergistically with statins and ezetimibe.
- PCSK9 blockade prevents receptor degradation so the liver clears more LDL particles.
Six Month PCSK9 Option To Improve Adherence
- Consider inclisiran (Leqvio) for patients who dislike frequent injections to improve adherence.
- Administered by a provider every six months subcutaneously, it lowers PCSK9 similarly while reducing injection frequency.
CAC Scoring For Uncertain Midlife Risk
- Use coronary artery calcium (CAC) scoring for middle‑aged patients where risk is uncertain to guide treatment decisions.
- Best for men 40–60 and women 50–70; high scores (eg, ≥400) indicate need for aggressive therapy and once positive, repeated scans add little.