Guidelines Can't See Your Patient

What this episode covers

Four episodes. One guideline. One honest answer to the question nobody asks at the end of a guideline review: what do we actually do now?This finale recaps the four key takeaways from the 2026 ACC/AHA Dyslipidemia series, addresses the non-statin evidence gap, and closes with the argument that matters most — the one about the patient sitting across from you.📊 Four Takeaways:• COR 1 + LOE C-EO = a vote, not a trial. They carry the same label.• The LDL targets (<70, <55) were inferred from achieved drug-trial levels — never prospectively tested as targets• Universal Lp(a) screening is COR 1 for a marker with no approved specific therapy and an outcomes trial still pending• The risk calculator was replaced with no outcomes evidence — 17M reclassified, 4.1M de-prescribed, 15.8M eligible patients still untreated💊 Non-Statins in Brief:• Bempedoic acid (CLEAR Outcomes): strongest non-statin outcomes case — modest ARR in statin-intolerant patients• Inclisiran: COR 2a in the guideline; primary endpoints are LDL surrogates only• Evinacumab: COR 2b for homozygous familial hypercholesterolemia — affects 1 in 300,000🏆 Series Final Castelli Coefficient: 6/10"Read it. Use it. Know which parts have a foundation and which parts have a vote."📺 Full Series:Ep 4 — 2026 Guideline OverviewEp 5 — LDL Targets: What the Evidence Actually ShowsEp 6 — Screen Everyone for Lp(a)? What the Guideline Doesn't Tell YouEp 7 — 17 Million Americans Lost Their Statin Prescription. Nobody Ran a Trial First.📚 Series Sources:Blumenthal RS et al. 2026 ACC/AHA Dyslipidemia Guideline. JACC/Circulation. March 13, 2026. DOI: 10.1016/j.jacc.2025.11.016Cannon CP et al. NEJM 2015;372:2387 (IMPROVE-IT)Sabatine MS et al. NEJM 2017;376:1713 (FOURIER)Schwartz GG et al. NEJM 2018;379:2097 (ODYSSEY OUTCOMES)Ray KK et al. NEJM 2020;382:1507 (ORION)Lee YJ et al. NEJM 2026 (Ez-PAVE). DOI: 10.1056/NEJMoa2600283Ridker PM et al. NEJM 2024;391(22):2087 (Women's Health Study)Anderson TS et al. JAMA Intern Med. 2024;184(8):963 (PREVENT)Nissen SE et al. NEJM 2023;388:1353 (CLEAR Outcomes — bempedoic acid)👤 Gregory Castelli, PharmD, FCCP, BCPS, BC-ADM, CDCESAssociate Professor | Director of Academic and Clinical PharmacyDispense As Written, LLC🎙️ YouTube: @dispenseaswritten📸 Instagram/TikTok: @gregcastellipharmd🐦 X/Twitter: @gregcastellirx📧 [email protected]⚖️ LEGAL DISCLAIMER: This content is produced by Dispense As Written, LLC and is intended for educational purposes for healthcare professionals only. It does not constitute medical advice and should not be used to guide individual patient care decisions. The information presented reflects the evidence available at the time of filming and may not incorporate subsequent publications or guideline updates. Always consult current clinical guidelines, peer-reviewed literature, and your own professional judgment when making clinical decisions. Dispense As Written, LLC operates independently of Gregory Castelli's academic and institutional roles. No pharmaceutical sponsorship, funding, or promotional consideration was received in the production of this content.#DispenseAsWritten #familymedicine #primarycare #EBM #MedEd

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