New guidelines for managing cholesterol released
The American College of Cardiology (ACC) and American Heart Association (AHA), along with nine other medical groups, released the 2026 Guideline on the Management of Dyslipidemia on March 13, 2026, replacing the 2018 cholesterol guidelines. This update broadens focus from just cholesterol to all blood lipids like triglycerides and emphasizes earlier intervention to cut lifelong atherosclerotic cardiovascular disease (ASCVD) risk.
Key Changes
The guidelines introduce the PREVENT-ASCVD risk calculator for adults 30-79 without known ASCVD, categorizing 10-year risk as low (<3%), borderline (3-<5%), intermediate (5-<10%), or high (≥10%) to guide therapy. They reinstate specific LDL-C and non-HDL-C targets, recommend lifetime Lp(a) testing (high levels ≥125 nmol/L raise ASCVD risk 1.4-fold), selective apoB measurement, and coronary artery calcium (CAC) scans for risk refinement in uncertain cases.
LDL-C Targets
Targets vary by risk level to minimize lifetime lipid exposure.
Treatment Approach
Start with lifestyle changes: healthy weight, exercise, no tobacco, good sleep. Add high-intensity statins as foundation; if needed, include ezetimibe, bempedoic acid, or PCSK9 inhibitors for further LDL-C reduction. For high triglycerides, prioritize lifestyle and statins, escalating based on ASCVD/pancreatitis risk.
Special Groups
Screen children 9-11 for cholesterol; start therapy in adults ≥40 with CKD stage 3+, HIV, or diabetes. Continue during cancer treatment if not contraindicated; defer in pregnancy/lactation. South Asian ancestry counts as a risk enhancer.
