Brazil Sets Stricter Cholesterol Targets, Adds 'Extreme Risk' Category With LDL Under 40 mg/dL

Overview

• The Sociedade Brasileira de Cardiologia’s new guideline lowers LDL goals across risk tiers and introduces an extreme-risk group for patients with multiple prior cardiovascular events, targeting LDL below 40 mg/dL.
• Revised LDL thresholds are now set at under 115 mg/dL for low risk, under 100 mg/dL for intermediate, under 70 mg/dL for high, under 50 mg/dL for very high, and under 40 mg/dL for extreme risk.
• Adults are advised to have a one-time lipoprotein(a) measurement to identify genetically driven risk, though the test is not offered by SUS and lacks broad health-plan coverage.
• For high to extreme risk, the guideline favors starting combination lipid-lowering therapy, including statins with ezetimibe, PCSK9 inhibitors, or bempedoic acid, with possible triple regimens that can cut LDL by up to about 85%.
• Clinicians are urged to use comprehensive 10-year risk calculators such as the Prevent score, and the update also sets co‑primary targets for non‑HDL cholesterol, including an ideal of up to 145 mg/dL for low risk and up to 70 mg/dL for extreme risk.