2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: (JACC May 2026-2)-Article: ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia

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The 2026 ACC/AHA dyslipidemia guideline replaces the 2018 blood cholesterol guideline and broadens focus from LDL-C alone to overall atherogenic lipoproteins, including triglycerides and lipoprotein(a). It emphasizes earlier prevention across the lifespan, with universal lipid screening in adults starting at age 19 and every 5 years, and screening children at 9–11 years or earlier in families with premature ASCVD or familial hypercholesterolemia (FH).<br /><br />Key updates include recommending the PREVENT-ASCVD equations instead of the older pooled cohort equations for 10- and 30-year ASCVD risk estimation. Risk discussion should be personalized using risk enhancers, reproductive risk markers, CAC scoring, and in some cases apoB and Lp(a). Lp(a) should be measured at least once in all adults.<br /><br />Lifestyle remains foundational: heart-healthy diets, physical activity, weight control, sleep, stress management, and tobacco avoidance. Dietary supplements are not recommended for lipid lowering. Referral to a registered dietitian is recommended for severe hypertriglyceridemia and helpful for CKM syndrome.<br /><br />Statins remain first-line therapy for primary and secondary prevention. The guideline reintroduces LDL-C and non-HDL-C treatment goals, with stronger targets for higher risk. In primary prevention, statins are considered at borderline risk (3%–5%) and recommended at intermediate risk (5%–10%), with high-intensity therapy for high risk (10%). In secondary prevention, most patients should aim for LDL-C 55 mg/dL and non-HDL-C 85 mg/dL, especially if very high risk.<br /><br />Newer nonstatin options are incorporated more explicitly: ezetimibe, PCSK9 inhibitors, bempedoic acid, inclisiran, and in rare cases evinacumab or lomitapide for HoFH. Hypertriglyceridemia management prioritizes lifestyle, statins, and in selected cases fibrates, prescription omega-3s, or olezarsen for familial chylomicronemia syndrome. Special guidance is provided for diabetes, CKD, HIV, pregnancy, children, older adults, cancer survivors, heart failure, and statin-associated muscle symptoms.

Meta Tag

Concept Dyslipidemia

Concept Lipid Screening

Concept ASCVD Risk Stratification

Concept Lifestyle Intervention

Concept Lipid-Lowering Pharmacotherapy

Concept Statin

Keywords

dyslipidemia

LDL-C

triglycerides

lipoprotein(a)

PREVENT-ASCVD

statins

familial hypercholesterolemia

coronary artery calcium

nonstatin therapy

hypertriglyceridemia

Dyslipidemia

Lipid Screening

ASCVD Risk Stratification

Lifestyle Intervention

Lipid-Lowering Pharmacotherapy

Statin