Repeat lipid testing

I am writing to thank Dr Kolber and colleagues for this important work—the simplified lipid guideline update that appeared in the October 2023 issue of Canadian Family Physician.¹ I would like to ask the authors to reconcile what appears to be conflicting or missing advice: the recommendation “against the use of repeat lipid testing and cholesterol targets after a patient begins lipid-lowering therapy” and the additional recommendation of “discussing the initiation of ezetimibe or PCSK9 [proprotein convertase subtilisin-kexin type 9] inhibitors” for secondary prevention.¹ How do we identify those patients who should have the discussion about ezetimibe or PCSK9 inhibitors if not by repeat lipid testing? Is the evidence for ezetimibe and PCSK9 inhibitors not mostly in patients who are not “at target”?

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