Evaluation and Diagnosis

Management

Complications of Management

Document Overview

Design and created by Guideline Central in participation with the American College of Cardiology and American Heart Association.

Management of Dyslipidemia

American College of Cardiology

American Heart Association

Publication Date: Mar 13, 2026

Page Last Updated: Jun 2, 2026

Class of Recommendations and Level of Evidence

Class (Strength) of Recommendation
CLASS 1 (STRONG) Benefit >>> Risk
Suggested phrases for writing recommendations: Is recommended Is indicated/useful/effective/beneficial Should be performed/administered/other Comparative-Effectiveness Phrases^†: Treatment/strategy A is recommended/indicated in preference to treatment B Treatment A should be chosen over treatment B
CLASS 2a (MODERATE) Benefit >> Risk
Suggested phrases for writing recommendations: Is reasonable Can be useful/effective/beneficial Comparative-Effectiveness Phrases^†: Treatment/strategy A is probably recommended/indicated in preference to treatment B It is reasonable to choose treatment A over treatment B
CLASS 2b (WEAK) Benefit ≥ Risk
Suggested phrases for writing recommendations: May/might be reasonable May/might be considered Usefulness/effectiveness is unknown/unclear/uncertain or not well established
CLASS 3: No Benefit (MODERATE) (Generally, LOE A or B use only) Benefit = Risk
Suggested phrases for writing recommendations: Is not recommended Is not indicated/useful/effective/beneficial Should not be performed/administered/other
CLASS 3: Harm (STRONG) Risk > Benefit
Suggested phrases for writing recommendations: Potentially harmful Causes harm Associated with excess morbidity/mortality Should not be performed/administered/other

Level (Quality) of Evidence^‡
LEVEL A
High-quality evidence^‡ from more than 1 RCT Meta-analyses of high-quality RCTs One or more RCTs corroborated by high-quality registry studies
LEVEL B-R (Randomized)
Moderate-quality evidence^‡ from 1 or more RCTs Meta-analyses of moderate-quality RCTs
LEVEL B-NR (Nonrandomized)
Moderate-quality evidence^‡ from 1 or more well-designed, well-executed nonrandomized studies, observational studies, or registry studies Meta-analyses of such studies
LEVEL C-LD (Limited Data)
Randomized or nonrandomized observational or registry studies with limitations of design or execution Meta-analyses of such studies Physiological or mechanistic studies in human subjects
LEVEL C-EO (Expert Opinion)
Consensus of expert opinion based on clinical experience

COR and LOE are determined independently (any COR may be paired with any LOE).

A recommendation with LOE C does not imply that the recommendation is weak. Many important clinical questions addressed in guidelines do not lend themselves to clinical trials. Although RCTs are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective.

* The outcome or result of the intervention should be specified (an improved clinical outcome or increased diagnostic accuracy or incremental prognostic information).
^† For comparative-effectiveness recommendations (COR I and IIa; LOE A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated.
^‡ The method of assessing quality is evolving, including the application of standardized, widely used, and preferably validated evidence grading tools; and for systematic reviews, the incorporation of an Evidence Review Committee.

COR indicates Class of Recommendation; EO, expert opinion; LD, limited data; LOE, Level of Evidence; NR, nonrandomized; R, randomized; RCT, randomized controlled trial.

Document Overview

Document Title: Management of Dyslipidemia

Authoring Societies

American College of Cardiology

American Heart Association

Endorsing Societies

American Diabetes Association

American Geriatrics Society

National Lipid Association

American Society of Preventive Cardiology

Document Publication Date: Mar 13, 2026

Page Last Reviewed/Updated: Jun 2, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.jacc.org/doi/10.1016/j.jacc.2025.11.016

Source Citation: Blumenthal, RS, Morris, PB, Gaudino, M, Johnson, HM, Anderson, TS, Bittner, VA, Blankstein, R, Brewer, LC, Cho, L, de Ferranti, SD, Gianos, E, Gluckman, TJ, Gradney, K, Isiadinso, I, Lloyd-Jones, DM, Marrs, JC, Martin, SS, McLain, KH, Mehta, LS, Mora, S, Mulugeta, WM, Natarajan, P, Navar, AM, Orringer, CE, Polonsky, TS, Reynolds, HR, Saseen, JJ, Shapiro, MD, Soffer, DE, Tynes, SA, Villavaso, CD, Virani, SS, Wilkins, JT. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. [published online ahead of print March 13, 2026]. J Am Coll Cardiol. doi: 10.1016/j.jacc.2025.11.016.

Copublished in Circulation. doi: 10.1161/CIR.0000000000001423

Document Scope, Criteria, and Use Cases

Document Objectives: To provide evidence-based recommendations on preventing and managing dyslipidemias

Scope: Assessment and Screening, Diagnosis, Management, Prevention, Treatment

Diseases/Conditions (MeSH)

D050171 - Dyslipidemias

D000090542 - Homozygous Familial Hypercholesterolemia

Keywords: ASCVD , American Heart Association Predicting Risk of cardiovascular disease EVENTs, Apolipoprotein B (ApoB), CKM syndrome, Cardiovascular-kidney-metabolic syndrome, LDL-C, Lp(a), Lp(a) Screening, PCSK9 mAb, PREVENT™, Subclinical atherosclerosis, atherogenic lipoproteins, bempedoic acid, coronary artery calcium, dyslipidemia, ezetimibe, familial hypercholesterolemia, lifestyle intervention, lifestyle optimization, lipid-lowering therapy, lipoprotein(a), low-density lipoprotein-cholesterol, non–HDL-C, premature atherosclerotic cardiovascular disease, statin therapy, triglycerides

Target Patient Population: Patients with or at risk of developing dyslipidemia

Target Provider Population: Clinicians managing care for patients with or at risk of developing dyslipidemia

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Older Adult

Health Care Settings: Ambulatory, Correctional Facility, Laboratory Services, Long Term Care, Outpatient, Telehealth

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Management of Dyslipidemia

Evaluation and Diagnosis

3.1. Screening in Children and Adults

3.2. Measurement of TC, LDL-C, HDL-C, Triglycerides, and Non–HDL-C

3.3. Measurement of Apolipoprotein B

3.4. Measurement of Lipoprotein (a)

3.5. Monitoring and Follow-Up

Management

4.1. Lifestyle Management

4.1.1. Primordial Prevention of Dyslipidemia: Childhood Through Adulthood

4.1.2. Dietary Approaches in Dyslipidemia

4.1.2.1. Dietary Management of LDL-C Disorders

4.1.2.2. Lifestyle Management of Hypertriglyceridemia

4.1.3. Attainment and Maintenance of Healthy Weight in People With Dyslipidemia

4.1.4. Physical Activity

4.1.5. Dietary Supplements

4.1.6. When to Refer to a Registered Dietitian Nutritionist

4.2. Medical Management

4.2.3. Primary Prevention in Adults

4.2.3.1. Role of the Individualized Benefit-Risk Discussion

4.2.3.2. PREVENT-ASCVD Equations

4.2.3.3. Risk Enhancers

4.2.3.4. Reproductive Risk Markers

4.2.3.5. Polygenic Risk Scores

4.2.3.6. Selective Imaging of Subclinical Atherosclerosis (Men ≥40 or Women ≥45 Years)

4.2.3.7. Primary Prevention in Adults 30 to 79 Years With LDL-C Levels 70 to 189 mg/dL (1.8–4.9 mmol/L)

Low (<3%) Estimated 10-Year ASCVD Risk

Borderline (3% to <5%) and Intermediate (5% to <10%) 10-Year ASCVD Risk

High (≥10%) 10-Year Estimated ASCVD Risk

Special Considerations in Primary Prevention

4.2.4. Severe Hypercholesterolemia (LDL-C ≥190 mg/dL [4.9 mmol/L])

4.2.4.1. Role of Risk Assessment in Heterozygous Familial Hypercholesterolemia (HeFH)

4.2.4.2. Genetic Testing for Familial Hypercholesterolemia

4.2.4.3. Severe Hypercholesterolemia With LDL-C ≥190 mg/dL (4.9 mmol/L)*

Severe Hypercholesterolemia in Primary Prevention (Without HeFH, Subclinical Atherosclerosis, and Additional ASCVD Risk Factors)

Severe Hypercholesterolemia With HeFH, Subclinical Atherosclerosis, or With Additional Risk Factors

Severe Hypercholesterolemia With Clinical ASCVD

Inclisiran in Severe Hypercholesterolemia

4.2.4.4. Severe Hypercholesterolemia With Clinical or Genetic Confirmation of Homozygous Familial Hypercholesterolemia (HoFH)

4.2.5. Diabetes in Adults Without Established ASCVD

4.2.6. Secondary ASCVD Prevention

Clinical ASCVD Not at Very High Risk*

Clinical ASCVD at Very High Risk*

Heart Failure With Reduced Ejection Fraction (HFrEF) Due to ASCVD

4.2.7. Management of Adults With Subclinical Coronary Atherosclerosis (Men ≥40 or Women ≥45 Years)

4.2.8. Considerations in Patient Management

4.2.8.1. Children and Adolescents

4.2.8.2. Young Adults Ages 18 to 39 Years of Age

4.2.8.3. Older Adults

4.2.8.4. Management of Dyslipidemia in Persons Planning Pregnancy, During Pregnancy, or While Lactating

4.2.8.5. Considerations Based on Ancestry

4.2.8.6. Adults With Heart Failure

4.2.8.7. Adults With Chronic Inflammatory Diseases (CID)

4.2.8.8. Adults With Chronic Kidney Disease – Stage 3 or Higher

4.2.8.9. Persons Living With Human Immunodeficiency Virus (HIV)

4.2.8.10. Adults With Cancer or History of Cancer

4.2.9. Management of Hypertriglyceridemia

4.2.10. Approach to Patients With Elevated Lp(a)

4.2.11. Management of Statin-Attributed Muscle Symptoms

Complications of Management

5.1. Medication Safety and Therapy-Associated Side Effects

5.2. Statin-Cardiovascular Drug Interactions

Class of Recommendations and Level of Evidence

Document Overview

Document Scope, Criteria, and Use Cases

4.2.4.3. Severe Hypercholesterolemia With LDL-C ≥190 mg/dL (4.9 mmol/L)^*

Clinical ASCVD Not at Very High Risk^*

Clinical ASCVD at Very High Risk^*