New ACC/AHA 2026 Lipid Targets

The ACC and AHA, together with nine partner societies, issued the multisociety 2026 dyslipidemia guideline on March 13, 2026, formally replacing the 2018 blood‑cholesterol guidance. newsroom.heart.org The guideline replaces the pooled‑cohort equations with the new PREVENT ASCVD risk model and gives a Class I recommendation to estimate 10‑year risk with PREVENT for adults aged 30–79 years who have LDL‑C 70–189 mg/dL. ahajournals.org PREVENT categorizes 10‑year ASCVD risk as low <3%, borderline 3%–<5%, intermediate 5%–<10%, and high ≥10%, and the guideline advises considering lipid‑lowering therapy at 3%–5% with risk enhancers and at 5%–10% more strongly. patientcareonline.com The guideline restores routine screening windows (lipid panel at ages 9–11, again at 19–21, and at least every 5 years thereafter) and recommends considering pharmacotherapy for young adults with persistent LDL‑C ≥160 mg/dL, a strong family history of premature ASCVD, or a ≥10% 30‑year ASCVD risk. healio.com LDL‑C targets returned to the framework: any detectable coronary artery calcium supports a goal of <100 mg/dL, secondary prevention in very‑high‑risk patients tightens targets down toward <55 mg/dL, and the guideline reintroduces both LDL and non‑HDL numeric goals and percent‑reduction strategies. patientcareonline.com Statins remain first‑line, with a defined hierarchy for add‑ons: ezetimibe and/or bempedoic acid (Nexletol) next, then PCSK9 monoclonal antibodies, and consideration of inclisiran (Leqvio) for further lowering—changes that explicitly anticipate more combination therapy and earlier treatment intensification. prnewswire.com The document elevates testing for apolipoprotein B and lipoprotein(a) as part of individualized risk assessment and recommends selective use of coronary calcium scoring to reclassify uncertain cases, tools intended to shift decision‑making away from single lipid snapshots toward lifetime atherogenic exposure. ahajournals.org