Internal Medicine

2026 ACC/AHA dyslipidemia guideline broadens lipid management beyond LDL cholesterol

This guideline retires and replaces the 2018 ACC/AHA cholesterol guideline for clinical practice. It addresses evaluation, treatment, and monitoring of high cholesterol, hypertriglyceridemia, and elevated lipoprotein(a). Recommendations synthesize evidence from recent clinical trials, systematic reviews, and meta‑analyses through December 2024. The document is designed to guide everyday dyslipidemia care across primary and secondary prevention settings. 1

EMPACE shows striking underuse and delay of quadruple GDMT after HF hospitalization

Among 17,210 US patients hospitalized with HF, 73% had HFrEF with mean age about 69 years. Before hospitalization, only 1% of HFrEF patients received quadruple therapy despite relatively high beta‑blocker and ACEI/ARB use. After discharge, quadruple therapy increased only to 2%, with modest gains in ARNI and SGLT2 inhibitor use. Time to initiation was longest for SGLT2 inhibitors and shortest for beta‑blockers, delaying full GDMT implementation. Twelve‑month discontinuation was high across classes, especially for ARNI and mineralocorticoid receptor antagonists, highlighting fragile persistence. 2

Inflation Reduction Act reforms linked to less cost-related nonadherence in Medicare Part D

This difference‑in‑differences analysis used 2021–2024 National Health Interview Survey data for adults aged 62–67 years. Medicare Part D enrollees were compared with privately insured peers around 2024 prescription drug reforms. After reform, cost‑related medication nonadherence declined by 4.9 percentage points in Medicare beneficiaries relative to comparators. Among those with multiple chronic conditions, the relative decline reached 7.8 percentage points. Financial‑strain measures did not improve comparably, suggesting more targeted than global relief. 3

Primary-prevention statins in adults ≥80 associated with lower mortality and coronary events

This retrospective cohort included 15,745 adults aged ≥80 years without prior CVD from an Israeli health system. Persistent statin users had 31% lower all‑cause mortality and 20% fewer new coronary events than nonusers over about four years. No significant differences emerged in myopathy, new diabetes, or dementia between statin users and nonusers. Benefits were not seen in patients who discontinued statins before age 80, emphasizing continued therapy. Findings support considering ongoing primary‑prevention statins in selected very old adults without major intolerance. 4