New lipid guidelines drop

The 2026 ACC/AHA Multisociety Guideline on the Management of Dyslipidemia was published March 13, 2026 in Circulation and the Journal of the American College of Cardiology and was chaired by Roger S. Blumenthal, MD. (ahajournals.org) The panel endorses the AHA’s PREVENT equations for primary‑prevention risk estimation, a model derived and validated from datasets covering more than 6.5 million U.S. adults. (professional.heart.org) Under PREVENT, the guideline classifies a borderline 10‑year PREVENT‑ASCVD risk at 3%–<5% as “reasonable” for LDL‑lowering therapy and an intermediate risk of 5%–<10% as a recommendation after clinician‑patient discussion. (acc.org) Numerical LDL‑C goals are back: the guideline cites targets of <100 mg/dL for many in primary prevention, <70 mg/dL for those at high risk, and <55 mg/dL for very‑high‑risk secondary prevention, with tiered coronary artery calcium (CAC) cutoffs used to refine targets in subclinical disease. (acc.org) For biomarkers, the guideline recommends measuring lipoprotein(a) at least once in all adults and using apolipoprotein B (apoB) selectively to guide further intensification in patients with diabetes, high triglycerides, or on lipid‑lowering therapy. (guidelinecentral.com) The authors expand the role of non‑statin agents: PCSK9 inhibitors are endorsed when maximally tolerated statins do not achieve goals, and the guideline discusses inclisiran as a durable siRNA PCSK9‑lowering option while noting ongoing outcome trials and recent regulatory label updates. (acc.org) The 2026 document formally replaces the 2018 blood‑cholesterol guideline, specifically recommends lipid profiling beginning in young adults (recommended from age 19 with repeat at least every five years for younger adults), and is being highlighted at the ACC’s 75th Annual Scientific Session on March 28, 2026. (jamanetwork.com)