Reframing Lipid Strategies in Preventive Cardiology, with Payal Kohli, MD

Preventive cardiology is undergoing a transformation, driven by new therapies, advanced diagnostics, and a broader understanding of cardiovascular risk. As the field moves beyond traditional approaches, the focus is shifting toward more personalized, proactive care.

In a recent interview surrounding the American College of Cardiology (ACC) 2025 Annual Scientific Sessions, Payal Kohli, MD, an associate clinical professor of medicine at the University of Colorado School of Medicine and founder of Cherry Creek Heart, shares her expert perspective on recent advances and persistent gaps in lipid management.

Kohli describes a pivotal shift in preventive cardiology—moving beyond traditional lipid metrics to a broader, systemic approach to cardiovascular risk. Despite robust evidence supporting aggressive low-density lipoprotein cholesterol (LDL-C) lowering, particularly in secondary prevention, she emphasizes that practical barriers such as limited access to lipid testing and treatment continue to hinder patient outcomes. Kohli identifies emerging opportunities to close this gap through digital health tools and artificial intelligence (AI)-driven patient identification.

The discussion explores the growing role of non-statin therapies in the modern lipid-lowering armamentarium. Kohli advocates for a proactive approach to therapy initiation in the cardiac catheterization laboratory for patients presenting with acute coronary syndrome (ACS), where aggressive lipid-lowering should be viewed as a clinical emergency. She highlights the value of combination therapy and the urgency of achieving LDL targets early to maximize event reduction, citing data on evolocumab from the FOURIER open-label extension study.

Kohli also underscores the importance of lipoprotein(a) [Lp(a)] testing as a risk stratifier, calling it one of the most underused but clinically meaningful tools in preventive care. Drawing from the 2024 National Lipid Association guidelines, she outlines a multi-faceted strategy for Lp(a) management—including cascade screening, intensified LDL-C lowering, aspirin consideration in select patients, and preconception planning in high-risk women. With therapies targeting Lp(a) in late-stage development, Kohli stresses the need to prepare patients for a “parallel pathway of risk.”

This wide-ranging discussion highlights a key theme in contemporary cardiology: leveraging innovation not only in therapies, but in systems of care delivery, to improve outcomes in lipid management and cardiovascular prevention.

Relevant disclosures for Kohli include Agepha Pharma, Amarin, Amgen, AstraZeneca, Novartis, Merck, and others.