2026 Guideline on the Management of Dyslipidemia

Authors: Talia Holmes,  Lexus Jackson, DeYana Simpson, PharmD Candidates
Editor: Kristen Lindauer, PharmD, BCPS, AAHIVP

The American College of Cardiology (ACC)/ American Heart Association (AHA) published a new cholesterol guideline in March 2026 for the first time since the last updates in 2018. Join us for a brief breakdown of what changes this guideline brings to medical practice!

What is Dyslipidemia?

Dyslipidemia is defined as higher-than-normal concentrations of lipids in the bloodstream. Dyslipidemias considered in this guideline include elevated blood cholesterol, hypertriglyceridemia, and elevated Lipoprotein(a) (Lp(a)). Untreated dyslipidemia may lead to serious complications, including myocardial infarction, stroke, peripheral arterial disease, and increased risk of mortality. Current pharmacotherapy options include:

• LDL-C-lowering medications (such as 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) inhibitors)
• Triglyceride-lowering medications
• Non-statin therapies

New Guideline Changes

The new guideline introduces fixed LDL reduction goals, and it is now recommended to use the PREVENT-ASCVD equation in adults 30-79 instead of another equation, like the traditional Pooled Cohort, to classify 10-year ASCVD risk. The updated guideline provides new thresholds for low (10-year PREVENT-ASCVD risk < 3%), borderline (3 to <5%), intermediate (5 to <10%), and high (≥ 10%) risk. Lifestyle changes are first-line for all risk categories. Lipid-lowering therapy is reasonable for those with borderline risk and is recommended for those with intermediate to high risk. A selection of secondary testing, including coronary artery calcium (CAC) scans, Lp(a), and apolipoprotein B is now recommended when needed to improve cardiovascular risk assessments. The guideline also highlights the importance of early screening, especially in children. 

Earlier is Better

Early intervention is a primary focus of the updated guideline. Cholesterol screening is recommended for children as early as 2 years of age if they have a significant family history of ASCVD, severe hypercholesterolemia, or familial hypercholesterolemia. The ACC/AHA recommends that pharmacotherapy be considered in children who have a history of familial hypercholesterolemia and in young adults with LDL cholesterol (LDL-C) ≥160 mg/dL or a strong family history of ASCVD. For adults, a lipid panel should be obtained at age 19 and every 5 years thereafter. Testing for lipoprotein(a) is recommended at least once during adulthood. Apolipoprotein B should be tested to guide possibly further therapy in adults who are on lipid-lowering therapy and meet initial lipid goals.  

Who Qualifies for Pharmacotherapy?

Candidates for pharmacotherapy mainly remain consistent with prior guidelines and include patients with ASCVD, LDL ≥ 190 mg/dL, diabetes mellitus, and those with a high risk of ASCVD who quality for primary prevention. The updated guideline emphasizes thorough evaluation of risk enhancers in addition to a patient-provider discussion when considering primary prevention for those with borderline risk. Risk enhancers include

• an LDL-C ≥ 160 mg/dL
• family history of premature ASCVD,
• cardiovascular-kidney-metabolic (CKM) syndrome

Adults aged ≥ 40 with chronic kidney disease (CKD) stage 3 or higher, HIV, or diabetes are candidates for statin therapy regardless of 10-year PREVENT-ASCVD risk score. Patients with diabetes or CKD stage 3 or higher should be initiated on a moderate-intensity statin at least. The guideline does not specify the recommended statin intensity for patients with HIV. However, much of the data was with pitavastatin 4 mg (a moderate-intensity statin). 

Cholesterol Targets

The guideline also provides specific LDL-C and non-HDL goals. The new treatment goals are:

• Borderline or intermediate risk = LDL-C < 100 mg/dL and non-HDL-C < 130 mg/dL
• High risk = LDL-C < 70 mg/dL and non-HDL-C < 100 mg/dL
• Very high risk with ASCVD = LDL-C < 55 mg/dL and non-HDL-C < 85 mg/dL
• Patients with diabetes = the guideline suggests that lipid goals be determined with ASCVD risk and diabetes-specific risks rather than diabetes alone
• Adults aged 40-75 with diabetes = a moderate-intensity statin should be initiated with a goal of LDL-C < 100 mg/dL
• Patients with higher ASCVD or diabetes-specific risks = a high-intensity statin should be initiated with a goal of ≥ 50% LDL-C reduction and LDL-C < 70 mg/dL
• Patients with an even higher risk = a goal of LDL-C < 55 mg/dL in addition to nonstatin therapies should be considered

Optimizing Therapy

To optimize lipid-lowering therapy, it is essential that pharmacists are aware of the updates to the cholesterol guideline, including risk score, lipid goals, and indications for lipid-lowering therapy. The 2026 ACC/AHA dyslipidemia guideline emphasizes a more risk-based approach to dyslipidemia management by suggesting earlier screening and more defined treatment goals. By incorporating this approach into their everyday clinical skills, pharmacists can help improve patient outcomes and reduce the risk of cardiovascular events in patients.

About the Authors

References

1. Writing Committee Members, Blumenthal, R. S., Morris, P. B., Gaudino, M., Johnson, H. M., Anderson, T. S., … Wilkins, J. T. (n.d.). 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 0(0). doi:10.1161/CIR.0000000000001423
2. Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. JACC. Published online March 13, 2026. doi: 10.1016/j.jacc.2025.11.016
3. Barbara S. Wiggins, PharmD, FACC Ana Barac, MD, PhD, FACC Catherine P. Benziger, MD, MPH, FAHA, FACC Roger S. Blumenthal, MD, FACC, FAHA, FASPC, FNLA Morgane Cibotti-Sun, MPH Mykela M. Moore, MPH Pamela B. Morris, MD, FACC, FAHA, FASPC, FNLA