Cholesterol

Cardiovascular diseases: an Italia model for the management of dyslipidaemia

The aim of the Clear Pathway project is to bridge the gap between guidelines and actual clinical practice by promoting integrated oral therapies, therapeutic adherence and personalised care

by Giuseppe Musumeci*

10 April 2026

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3' min read

Translated by AI

Versione italiana

3' min read

Translated by AI

Versione italiana

Reducing LDL-cholesterol, often referred to as 'bad cholesterol', is one of the most effective strategies to prevent cardiovascular diseases, such as heart attack and stroke, still the main causes of mortality in Italy and worldwide. This applies both to those who have not yet had an event and to those who have already suffered one, for whom controlling LDL levels is essential to avoid relapses. Numerous studies show a direct relationship: the lower the LDL cholesterol, the greater the reduction in cardiovascular risk over time.

Increased therapeutic solutions

In recent years, the therapeutic possibilities have expanded significantly. Alongside the 'historical' statins, other drugs such as ezetimibe and, more recently, innovative therapies such as PCSK9 inhibitors, administered by injection, which allow a very marked reduction in LDL-cholesterol levels.

Bempedoic acid, a more recently introduced oral drug, also fits into this scenario. Well-tolerated, it represents the first therapeutic choice in patients not taking statins due to side effects; however, its role is not limited to this aspect: by ensuring a significant reduction in LDL-cholesterol, alone or in combination with other treatments, it represents a further opportunity to improve cardiovascular risk control.

Despite the availability of these therapies, in daily practice many patients still do not reach the cholesterol levels recommended by the guidelines. This may be due to several factors: insufficiently intensive therapies, difficulties in adherence in the long term or poor customisation of treatment.

The Clear Pathway project

It is precisely from this concrete need that the Clear Pathway project was born, with the aim of optimising cholesterol management in clinical practice. It is an initiative that has involved cardiologists from Piedmont and Valle d'Aosta, led by Federico Nardi, Giuseppe Musumeci, Giuseppe Patti and Ferdinando Varbella, who, through a structured method of comparison called mini-Delphi, have worked to define shared and easily applicable strategies in the management of dyslipidaemia.

At the heart of the project is the idea of optimising the use of oral hypolipidemic therapies, including bempedoic acid, by constructing simple and practical decision-making pathways that help physicians to quickly and effectively choose the most suitable therapy for each patient. The result has been the development of a true organisational model, reducing the differences between theory and practice and improving the achievement of therapeutic goals.

Development in the Regions

Perhaps the most important aspect of Clear Pathway is its concrete impact: it is not just a scientific work, but a model already adopted at regional level, with the aim of improving the quality of care and reducing the cardiovascular risk in the population. The experience gained in Piedmont and Valle d'Aosta now represents a point of reference and a basis for possible future developments.

In this perspective, the project arouses interest in other Italian regions. First and foremost Liguria, which, thanks to Italo Porto's contribution, represents one of the first contexts in which the model will be extended. The aim is to spread a more uniform and effective approach to cholesterol management throughout the country, fostering better control of cardiovascular risk and, ultimately, a reduction in events such as heart attack and stroke.

The results of the project were published in the Giornale Italiano di Cardiologia and presented by Federico Nardi at the International Congress Change in Cardiology in Turin (9-11 April), led by Giuseppe Musumeci, Giuseppe Patti, Italo Porto and Ferdinando Varbella, with over three thousand participants.

*Director S.C. Cardiology, Ospedale Mauriziano di Torino

In cooperation with:

Giuseppe Patti, Director of the Chair of Cardiology, Università Piemonte Orientale; Director, Thoraco-Cardio-Vascular Department, AOU Maggiore della Carità di Novara

Ferdinando Varbella, Director Cardio-Neurological Department ASL TO3 and Director S.C. Cardiology Rivoli (TO)

Italo Porto, Director of School of Specialisation, Department of Internal Medicine and Medical Specialities, University of Genoa; Director O.U. Cardiovascular Diseases Clinic IRCCS Policlinico San Martino Hospital, Genoa

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