The American Heart Association (AHA) and American College of Cardiology (ACC) have released the 2026 Clinical Practice Guidelines for the Management of Blood Cholesterol. This is the first significant update in eight years, replacing the 2018 guidelines. The 2026 update endorses a shift toward more aggressive lipid-lowering therapy and earlier intervention across the lifespan to reduce the cumulative burden of cholesterol. Highlights from the recommendations include the following:

• Screening: Initial lipid panels are now recommended starting at age 19. Routine Lipoprotein(a) screening is recommended once in a lifetime; levels ≥125 nmol/L indicate increased risk, while levels ≥250 nmol/L denote high risk. Apolipoprotein B (ApoB) is recommended for monitoring when LDL-C is low, but triglycerides remain elevated. Coronary artery calcium (CAC) scoring is generally recommended for men ≥40 years of age and women ≥45 years of age who have uncertain or borderline ASCVD risk. The new guidelines also include CAC-based treatment recommendations.


• Primary prevention: For predicting ASCVD risk, the PREVENT calculator, which incorporates kidney function and excludes race, is now recommended over the ASCVD Pooled Cohort Equations. High-intensity statins are the focus of therapy. For high-risk individuals (10-year risk ≥20%), the LDL-C goal is <70 mg/dL. For borderline or intermediate risk (5% to <20%), the target is <100 mg/dL.


• Secondary prevention: For "very high-risk" patients (multiple major ASCVD events or one event with multiple high-risk conditions), the LDL-C goal is <55 mg/dL. For other secondary prevention, the goal is <70 mg/dL. Non-statin therapies are prioritized if targets are not met.


• Hypertriglyceridemia: For persistent triglycerides (TG) 150-499 mg/dL on maximally tolerated statins, icosapent ethyl (IPE) is recommended. For Familial Chylomicronemia Syndrome (FCS) with TG ≥1000 mg/dL, the APOC3 inhibitor olezarsen is now a recommended option.

These guidelines highlight the need for early risk stratification and the use of combination therapies to achieve increasingly stringent LDL-C targets. Providers should transition to the PREVENT equations and incorporate Lp(a) testing into routine cardiovascular assessments to better identify patients who benefit from early, intensive lipid management.

• 2026 ACC/AHA Guideline on the Management of Dyslipidemia, Circulation (2026) [PubMed abstract]
• Cholesterol Treatment Guidelines