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Just published March 13th, 2026, the American College of Cardiology, along with the American Heart Association released an update to their guideline on the Management of Dyslipidemia. This update addresses the evaluation, management, and monitoring of individuals with dyslipidemias, including high blood cholesterol, hypertriglyceridemia, and elevated lipoprotein(a). 

In today’s rapid update, we’ll just be going over the 10 top take home messages. For the full guideline, including new and revised practice-changing recommendations, make sure to check it out on guidelinecentral.com

Let’s get started. 

  1. Treat dyslipidemia earlier to reduce lifelong risk of prolonged exposure to atherogenic lipoproteins. Health behavior counseling to support lifestyle optimization should start in youth, with early consideration of pharmacotherapy in youth with familial hypercholesterolemia  and in young adulthood in individuals with low-density lipoprotein-cholesterol, or LDL-C, ≥ 160 mg/dL or a strong family history of premature atherosclerotic cardiovascular disease, also known as ASCVD. 
  1. Use the more contemporary American Heart Association Predicting Risk of cardiovascular disease EVENTs, also known as PREVENT™ equations, instead of the older Pooled Cohort Equations for 10- and 30-year risk assessment to guide lipid-lowering therapy, also known as LLT, in primary prevention in adults aged 30 to 79 years. Use the “CPR” Model: A) Calculate 10-year ASCVD risk; B) Personalize the estimated risk to the specific patient by considering factors not included in PREVENT-ASCVD equations; and C) possibly Reclassify with selective use of coronary artery calcium and Reassess treatment recommendations.
  1. LDL-lowering therapy can be considered in adults for primary prevention of ASCVD with a 10-year PREVENT-ASCVD risk estimate of 3% to <5% and should be considered for those at 5% to <10% 10-year risk after a clinician–patient discussion.
  1. LDL-C and non–HDL-C treatment goals are back to guide LLT. Percentage reduction in LDL-C remains a priority for all individuals as well, with goal for % reduction depending on the level of ASCVD risk.
  1. Apolipoprotein B, or ApoB testing can be useful to improve risk assessment and guide therapy once LDL-C and non–HDL-C goals are met, particularly in those with elevated triglycerides, diabetes, or low achieved LDL-C. ApoB measurement helps identify adults with residual elevated lipoprotein-related risk that may be underestimated by the standard lipid profile alone and may be useful in the diagnosis of specific lipid and lipoprotein disorders.
  1. Lipoprotein(a) should be measured at least once to identify those individuals at higher risk of ASCVD. It is considered as a risk-enhancing factor at levels ≥125 nmol/L, which is associated with about a 1.4-fold increased ASCVD risk, and values ≥250 nmol/L are associated with ≥2-fold higher estimated risk. The presence of elevated Lp(a) should be an indication for more intensified LDL-C lowering and management of other risk factors.
  1. Coronary artery calcium scoring in men at least 40 years of age and women at least 45 years of age can improve risk assessment and guide LDL-C and non–HDL-C goals. Both the absolute amount of CAC and the corresponding standardized percentile have prognostic importance and help to reclassify risk in adults.
  1. LDL-lowering therapy is recommended for primary prevention in adults aged 40 to 75 years with diabetes, chronic kidney disease stage 3 or 4, or human immunodeficiency virus, regardless of LDL-C level. After age 75 years, LDL-C–lowering pharmacotherapy can be considered in conjunction with lifestyle interventions to reduce ASCVD risk.
  1. In secondary prevention, a goal of LDL-C <55 mg/dL and non–HDL-C <85 mg/dL is recommended for those at very high risk of ASCVD events. Although a smaller number of patients with ASCVD not at very high risk have an LDL-C goal of at least <70 mg/dL, the majority of those with a history of ASCVD events will likely qualify for an LDL-C goal of <55 mg/dL.
  1. And last, in patients with persistently elevated triglycerides, or TG, statin therapy remains the foundation of pharmacotherapy as an adjunct to lifestyle intervention to reduce ASCVD risk. Treatment for prevention of pancreatitis may also include TG-lowering therapies, especially in individuals with TG levels ≥1000 mg/dL. 

And there you have it. Make sure to check out the full guideline from the American College of Cardiology/American Heart Association and other related clinical decision support tools at guidelinecentral.com.

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