This guideline retires and replaces the 2018 AHA/ACC Guideline on the Management of Blood Cholesterol and is retitled the 2026 Guideline on the Management of Dyslipidemia to reflect the evolving understanding of atherosclerotic cardiovascular disease (ASCVD) risk associated with atherogenic lipoproteins beyond low-density lipoprotein cholesterol (LDL-C), including triglyceride-rich remnant particles and lipoprotein(a) [Lp(a)].
The guideline addresses the evaluation, management, and monitoring of individuals with lipid disorders, including high blood cholesterol, hypertriglyceridemia, and elevated Lp(a), incorporating new and updated recommendations based on clinical evidence through late 2024.
Key updates include the use of the American Heart Association PREVENT-ASCVD equations to guide primary-prevention lipid-lowering therapy decisions; testing Lp(a) at least once in a lifetime and selective apolipoprotein B (ApoB) measurement to improve risk assessment and guide treatment; the return of LDL-C and non-high-density lipoprotein cholesterol (HDL-C) treatment goals (with lower targets for higher-risk groups); and expanded use of coronary artery calcium (CAC) scoring to reclassify risk.
In this brief overview, Writing Committee Chair Roger S. Blumenthal, MD, FACC, FAHA, FASPC, FNLA, and Vice Chair Pamela B. Morris, MD, FACC, FAHA, FASPC, FNLA, highlight key changes, including the incorporation of the American Heart Association PREVENT-ASCVD equations, updated LDL-C goals, expanded biomarker use (apoB, Lp(a)), and five new FDA-approved lipid-lowering therapies. They also review practical algorithms for diabetes, ASCVD, statin intolerance, and specific populations.
