New lipid testing guidance

U.S. heart specialists now say adults should get a one-time lipoprotein(a) blood test, adding a genetic risk check to routine cholesterol care. (heart.org) The updated dyslipidemia guideline was issued March 13, 2026, by the American College of Cardiology, the American Heart Association, and nine other medical societies, replacing the 2018 blood cholesterol guideline. (acc.org) A standard lipid panel measures cholesterol carried in the blood. Apolipoprotein B, or ApoB, measures the number of cholesterol-carrying particles that can lodge in artery walls, which the American Heart Association compares to counting cars instead of passengers on a highway. (heart.org) The 2026 guideline says lipoprotein(a), written Lp(a), should be tested at least once in a lifetime and ApoB should be measured selectively to sharpen risk assessment and guide treatment. It also restores low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol treatment goals, with lower targets for higher-risk patients. (heart.org) Lp(a) is not part of a routine cholesterol panel, and its level is mostly inherited rather than changed much by diet or exercise. The Centers for Disease Control and Prevention says high Lp(a) raises the likelihood of heart attack, stroke, and aortic stenosis. (cdc.gov) The one-time recommendation reflects that stability over a lifetime. The guideline and related American Heart Association materials say Lp(a) levels are largely genetically determined and usually do not change much after they are measured. (heart.org; heart.org) ApoB enters the picture when the usual cholesterol numbers can miss risk. The American Heart Association says two people can have the same low-density lipoprotein cholesterol level but different ApoB levels, especially in people with high triglycerides, metabolic syndrome, or diabetes. (heart.org) The National Lipid Association said in a 2024 consensus that ApoB tracks atherosclerotic cardiovascular disease risk more closely than low-density lipoprotein cholesterol when the two measures do not agree. Its summary lists ApoB thresholds of 90 milligrams per deciliter for borderline to intermediate risk, 70 for high risk, and 60 for very high risk when clinicians consider intensifying treatment. (lipid.org) The new document also broadens lipid care beyond a single “bad cholesterol” number. It adds the American Heart Association PREVENT-ASCVD equations for primary prevention decisions and expands use of coronary artery calcium scoring to reclassify risk. (heart.org) The writing committee said the goal is earlier treatment and lower lifetime exposure to artery-clogging particles. Roger Blumenthal of Johns Hopkins, who chaired the guideline committee, said in the ACC release that clinicians should consider lipid-lowering medication earlier than they would have 10 years ago when lifestyle changes alone do not bring levels into range. (acc.org)