Dosage of lipoproteins for risk management according to guidelines - 28/05/26

Doi : 10.1016/j.vasdi.2026.05.001

Christophe Bonnin ^a,^b,⁎ , Caroline Fourgeaud ^c, Guillaume Mahé ^d, Khalil Ezzaki ^e, Marc Gras ^f, François Xavier Himpens ^g, Romain Jacquet ^h, Lina Khider ⁱ, Tristan Mirault ^j, Jean Noël Poggi ^k, Stéphane Zuily ^l, Judith Catella-Chatron ^m, Michel Farnier ⁿ
on behalf the
Guidelines Committee of the French Society of Vascular Medicine

^a Vascular Medicine and Explorations Unit, Pasteur Hospital, Nice University Hospital, Nice, France

^b Vascular Medicine, 32, boulevard Dubouchage, 06000 Nice, France

^c Basque Coast Cardiology and Diagnostic Center, 28, allée du Docteur-Robert-Lafon, 64100 Bayonne, France

^d University of Rennes, M2S, 35000 Rennes, France

^e Vascular Medicine, Clinique Clémentville, Groupe Oc Santé, Montpellier, France

^f Vascular Medicine, Cabinet Magellan, 314, avenue Polonia, 62110 Hénin-Beaumont, France

^g Allency Group, Vascular Medecine Team, 4, place Thiers, 59120 Loos, France

^h Vascular Medicine Practice, 16, boulevard de la Paix, 51100 Reims, France

ⁱ Université Paris Cité, Inserm, Paris Cardiovascular Research Centre (PARCC), Team Endotheliopathy and Hemostasis Disorders, Département de Médecine Vasculaire, Hôpital Européen Georges-Pompidou, AP–HP.Centre, Université Paris Cité, Paris, France

^j Université Paris Cité, Inserm, Paris Cardiovascular Research Centre (PARCC), Département de Médecine Vasculaire, Hôpital Européen Georges-Pompidou, AP–HP, Paris, France

^k Department of Vascular Medicine, Centre Hospitalier Intercommunal Toulon-La Seyne, 83000 Toulon, France

^l Vascular Medicine Division and National Referral Center for Rare Systemic Autoimmune Diseases, CHRU de Nancy, Inserm UMR_S 1116 DCAC, Lorraine University, Nancy, France

^m Department of Internal Medicine, Hôpital Édouard-Herriot, Hospices Civils de Lyon, Lyon, France

ⁿ Cerebrocardiovascular Pathophysiology and Epidemiology (PEC2), EA 7460, Bourgogne Europe University, Dijon, France

^* Corresponding author at: Unité de médecine et d’explorations fonctionnelles vasculaire, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France. Unité de médecine et d’explorations fonctionnelles vasculaire, hôpital Pasteur 2 30, voie Romaine Nice 06000 France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 28 May 2026

Abstract

LDL cholesterol (LDL-C) measurement is a key component in assessing cardiovascular disease risk and managing dyslipidemia. Despite irrefutable evidence that LDL-C–targeted strategies effectively reduce the risk of cardiovascular events, there is considerable variability among individuals in response to lipid-lowering therapies and in the resulting reduction of cardiovascular risk. Focusing solely on LDL-C assessment and management is no longer an optimal strategy for all patients. A major concern also lies in the potential for substantial errors in risk estimation, given the recognized measurement or calculation inaccuracies of LDL-C in patients with hypertriglyceridemia. Furthermore, the imprecision of calculated or measured LDL-C is less acceptable in the era of new lipid-lowering therapies that achieve very low LDL-C levels. This text, through existing recommendations, highlights the reasons why it has become necessary to use biomarkers beyond LDL-C to identify and treat patients at high cardiovascular risk.

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Keywords : LDL cholesterol, Non-HDL cholesterol, Apolipoprotein B, Cardiovascular risk, Guidelines