New ACC and AHA Cholesterol Management Guidelines

HEADLINE SCIENCE

APRIL 29, 2026 - The American College of Cardiology (ACC) and American Heart Association (AHA) have updated their cholesterol management guidelines, advocating for earlier and more aggressive intervention based on the understanding that cumulative lifetime exposure to high LDL-C drives atherosclerotic cardiovascular disease (ASCVD) risk.

The guidelines aim to standardize care for dyslipidemia (high cholesterol, triglycerides, and Lp[a]) by introducing several key changes:

1. New PREVENT-ASCVD Risk Calculator: This tool replaces traditional scores for more accurate 10-year and lifetime ASCVD risk prediction, leading to earlier statin therapy recommendations.
2. Lower LDL-C Targets: The guidelines push for lower LDL-C treatment goals, especially for high-risk patients, often requiring combination therapy.
3. Universal Lipoprotein(a) (Lp[a]) Testing: A major new recommendation is one-time testing for all patients. Elevated Lp(a) is an independent, genetic risk factor, and identifying it is crucial for intensive risk modification, particularly as new therapies emerge.

The intent of the clinical guidelines is to  help provide clinicians with consistent methods of evaluating, managing, and monitoring patients with dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a).  In addition, the joint organizations recommend a new ASCVD risk calculator to recalibrate risk categories, push LDL-C targets lower, and advise one-time lipoprotein(a) (Lp[a]) testing for all patients. Using the PREVENT-ASCVD calculator, the 10-year risk categories have been recalibrated:

• Low risk: less than 3% (previously less than 5% based on the PCEs)
• Borderline risk: 3% to less than 5% (previously 5% to less than 7.5%)
• Intermediate risk: 5% to less than 10% (previously 7.5% to less than 20%)
• High risk: 10% or higher (previously 20% or higher)

In summary, the 2026 ACC/AHA guidelines shift the focus to aggressive management of lifetime lipid exposure, using precise risk stratification and incorporating novel factors like Lp(a) into routine practice.

Learn More About the New ACC and AHA Guidelines

For further details and instruction about what is new, please refer to https://www.jacc.org/doi/10.1016/j.jacc.2025.11.016