Background: Although international guidelines recommend increasingly lower thresholds for low-density lipoprotein cholesterol (LDL-C), everyday clinical experience shows that many patients fail to reach these targets, exposing themselves to a significant residual cardiovascular risk. Clear Pathway - a patient-centered approach to dyslipidemia - was developed to bridge this gap by promoting an integrated use of oral lipid-lowering therapies.
Methods: In the Clear Pathway project, a panel of hospital cardiologists applied a mini-Delphi methodology in two rounds to evaluate 20 statements related to lipid-lowering therapy, divided into three thematic areas: oral combination and fixed-dose strategies; use of LDL-C target distance as a guide to treatment decisions; and personalization based on patient's clinical profile. Each statement was rated on a 1-5 Likert scale and approved if the average score was ≥4.0. Statements not approved in the first round were reformulated and resubmitted.
Results: In the first round, 17 out of 20 statements met the consensus threshold and were approved without any modification. The three statements not approved (early intensification in post-acute coronary syndrome patients with LDL-C <140 mg/dl, use of bempedoic acid in patients undergoing elective angioplasty, and in those one with stroke) were reformulated and resubmitted during a second round, where they also reached the approval threshold.
Conclusions: The Clear Pathway recommendations outline a model for dyslipidemia management based on integrated oral therapies, with a key role for bempedoic acid. Adopting these guidelines is expected to improve adherence, optimize achievement of LDL-C targets, and reduce the incidence of cardiovascular events in routine clinical practice.