{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:24:36Z","timestamp":1786944276701,"version":"build-2736575974"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Despite achieving guideline-recommended lipid levels, patients with atherosclerotic cardiovascular disease (ASCVD) retain substantial residual risk arising from heterogeneous biological pathways, including persistent inflammation and genetically determined atherogenic susceptibility. High-sensitivity C-reactive protein (hs-CRP) provides a pragmatic measure of potentially modifiable inflammatory activity, whereas lipoprotein(a) [Lp(a)] identifies relatively stable, genetically mediated risk that is not adequately captured by standard lipid panels. The 2025 American College of Cardiology Scientific Statement highlights hs-CRP as a clinically useful inflammatory-risk marker and supports consideration of low-dose colchicine in appropriately selected secondary-prevention patients. The 2026 ACC\/AHA multisociety dyslipidemia guideline further provides a Class I recommendation for once-in-a-lifetime Lp(a) measurement, creating a complementary multimodal framework for residual-risk assessment. In China, where cardiovascular disease accounts for a substantial proportion of deaths and the national cardiovascular burden continues to increase, implementation of this framework remains limited. Routine hs-CRP measurement is uncommon, cardiovascular use of colchicine remains negligible, and Lp(a) testing is still concentrated in selected tertiary centers. Emerging East Asian data and a recent Chinese expert advisory suggest that an hs-CRP threshold of approximately 1.0 mg\/L may improve inflammatory-risk discrimination in Chinese patients with coronary artery disease; however, this threshold should not yet be interpreted as a stand-alone treatment threshold for colchicine. In this perspective, we compare international recommendations with current Chinese practice, analyze barriers related to infrastructure, safety, education, standardization, and evidence localization, and propose a multimodal implementation framework. Short-term priorities include once-in-a-lifetime Lp(a) measurement, context-specific hs-CRP assessment, intensified management of modifiable atherosclerotic risk factors, and carefully selected use of low-dose colchicine in secondary prevention. Elevated Lp(a) should prompt comprehensive risk-factor intensification and, when appropriate, family-based evaluation, but should not by itself constitute an indication for colchicine. Medium- and long-term priorities include pragmatic trials, real-world registries, assay standardization, cost-effectiveness studies, and policy initiatives to integrate residual-risk assessment into Chinese cardiovascular prevention pathways.<\/jats:p>","DOI":"10.3389\/fmed.2026.1929544","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:34:43Z","timestamp":1786941283000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond lipids: a precision prevention blueprint for China's residual risk"],"prefix":"10.3389","volume":"13","author":[{"given":"Ming","family":"Chi","sequence":"first","affiliation":[{"name":"Graduate School, Heilongjiang University of Chinese Medicine","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taoming","family":"Qian","sequence":"additional","affiliation":[{"name":"Graduate School, Heilongjiang University of 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