A Synopsis of the 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for Lipid Management for Cardiovascular Disease Risk Reduction

DESCRIPTION: In December 2025, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) released a clinical practice guideline (CPG) update on lipid management for cardiovascular disease risk reduction in adults. This synopsis reviews the 2025 updates and describes the major recommendations. METHODS: The VA/DoD guideline development team updated the 2020 VA/DoD lipid management CPG with clinical stakeholders. The guideline panel developed 12 key questions, systematically evaluated the literature (English-language publications from 16 May 2019 to 15 January 2025), and developed 24 evidence-based recommendations. The recommendations were graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. RECOMMENDATIONS: This synopsis highlights key recommendations for lipid management that are new or differ from other guideline recommendations. This update recommends the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator for risk estimation in primary prevention and removes a previous recommendation against routine lipid monitoring. Two new risk refinement strategies were added: Coronary artery calcium testing is suggested for patients with clinical uncertainty and intermediate-to-high calculated risk, and one-time lipoprotein(a) testing is recommended to identify patients with enhanced cardiovascular risk. For primary prevention, moderate-intensity statins remain the recommended treatment for those at higher risk and should be considered for those at intermediate risk. A new recommendation suggests moderate-intensity statins for adults living with HIV even when 10-year risk is low. This update shifts toward more intensive lipid-lowering therapy for secondary prevention. For very high-risk patients with atherosclerotic cardiovascular disease, the guideline now suggests combination therapy with high-intensity or maximally tolerated statins plus ezetimibe and/or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. For statin-intolerant patients, alternatives include bempedoic acid, ezetimibe, fibrates, or PCSK9 monoclonal antibody inhibitors.