New Guidelines Aim to Lower Heart Disease Risk with Earlier Intervention and Updated Risk Assessment

WASHINGTON and DALLAS, March 13, 2026 — The American College of Cardiology (ACC), the American Heart Association (AHA), and nine other leading medical associations have jointly issued an updated guideline for the management of dyslipidemia—abnormal levels of lipids, including cholesterol and triglycerides, in the blood. Approximately 1 in 4 U.S. Adults has high levels of low-density lipoprotein-cholesterol (LDL-C), increasing their risk of heart attack and stroke.

A Comprehensive Approach to Dyslipidemia Management

The guideline consolidates evidence-based recommendations for managing dyslipidemias, offering a “one-stop shop” for assessing and treating blood lipids to lower an individual’s risk of developing atherosclerotic cardiovascular disease (ASCVD). ASCVD, caused by the buildup of fatty deposits in the arteries, is the leading cause of death globally. The document was published in JACC, the flagship journal of the ACC, and Circulation, the flagship journal of the AHA. Read more.

Focus on Early Intervention and Lifestyle Changes

A major focus of the new guideline is earlier intervention through healthy lifestyle changes, including maintaining a healthy weight, regular physical activity, avoiding tobacco, prioritizing sleep, and using cholesterol-lowering medication when recommended by a healthcare professional. The guideline too reinforces lower LDL-C goals and percent reduction based on risk to reduce lifetime exposure to unhealthy lipids and the risk of heart attack and stroke.

New Risk Assessment Tool: PREVENT-ASCVD

The guideline introduces the use of the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) risk calculator for primary prevention of ASCVD. The PREVENT-ASCVD equations are designed for adults aged 30-79 years without known ASCVD or subclinical atherosclerosis and with LDL-C levels between 70–189 mg/dL to estimate 10- and 30-year risk of heart attack or stroke and guide lipid-lowering therapy. Learn more about PREVENT-ASCVD.

Older risk scores, like the Pooled Cohort Equations, overestimated the 10-year risk of a heart attack and stroke by 40%-50%. The PREVENT-ASCVD equations classify 10-year ASCVD risk as:

• Low: <3%
• Borderline: 3% to <5%
• Intermediate: 5% to <10%
• High: 10% or higher

These risk categories guide treatment decisions, including whether to initiate statin therapy and the recommended intensity of lipid-lowering therapy.

Refining Risk Assessment with Additional Markers

The guideline recommends considering additional tests to improve cardiovascular risk assessment. These include:

• Coronary Artery Calcium (CAC) Scan: A non-contrast CAC scan can check for early calcium and plaque buildup in the heart’s arteries when there is uncertainty about a person’s true risk. It is recommended for men age 40 and older and women age 45 and older with borderline or intermediate 10-year risk if knowing CAC will assist with the decision to prescribe a statin.
• Lipoprotein(a) [Lp(a)]: Lp(a) should be measured at least once in adulthood. High Lp(a) levels (≥125 nmol/L or ≥50 mg/dL) are associated with an increased long-term risk of heart attack or stroke.
• Apolipoprotein B (apoB): Measuring apoB may be used to assess residual ASCVD risk and guide treatment among people with cardiovascular-kidney-metabolic syndrome, Type 2 diabetes, high triglycerides, or known cardiovascular disease who have reached their LDL-C and non-HDL-C goals.

Updated LDL-C Goals

The guideline re-establishes LDL-C and non-HDL-C treatment goals. For primary prevention, the LDL-C goal should be less than 100 mg/dL for those at borderline or intermediate risk and less than 70 mg/dL for those at high risk. For individuals with ASCVD, the LDL-C goal should be less than 55 mg/dL for secondary prevention.

Treatment Options

If lifestyle changes and statin therapy are insufficient, the guideline recommends adding non-statin therapies, such as ezetimibe and/or bempedoic acid, or a PCSK9 monoclonal antibody. Inclisiran is also being studied.

Managing Hypertriglyceridemia

Lifestyle changes and statin therapy remain the mainstay of treatment for hypertriglyceridemia, due to the increased risk of ASCVD. Other therapies may be needed based on an individual’s ASCVD and pancreatitis risk.

Special Considerations

The guideline outlines specific recommendations for optimizing lipid management in adults at increased risk, including those with chronic kidney disease, HIV, or Type 1 or Type 2 diabetes.

Childhood and Adolescent Cholesterol Screening

The guideline notes that high cholesterol can impact heart disease risk even in childhood and adolescence. Cholesterol screening is recommended for all children between the ages of 9-11 years.

“Implementation of this important new guideline by clinicians will be critical to reduce the burden of cardiovascular disease in the future,” said Pamela B. Morris, MD, FACC, FAHA, vice-chair of the guideline writing committee.

This guideline retires and replaces the 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Read the full guideline in JACC.