DALLAS \u2013 March 16, 2026 \u2013 New national guidance for managing cholesterol and other blood lipids calls for earlier risk assessment, more personalized treatment, and renewed emphasis on long-term cardiovascular prevention \u2013 changes experts say could significantly reduce heart attacks and strokes over a lifetime.<\/p>\n
As part of the updated recommendations, treatment to lower lipid levels may be considered starting at age 30 for adults at high long-term risk of heart disease or\u00a0high levels of low-density lipoprotein cholesterol (LDL-C), reflecting\u00a0growing evidence that intervention at a younger age can reduce long-term risk of heart attacks and strokes.<\/p>\n
Faculty from UT\u00a0Southwestern Medical Center played key roles in developing and reviewing the recommendations, which were released March 13 by the American College of Cardiology (ACC) and the American Heart Association (AHA) and endorsed by nine other major professional societies.<\/p>\n
The 2026 ACC\/AHA Guideline on the Management of Dyslipidemia, published simultaneously in the\u00a0Journal of the American College of Cardiology<\/a>\u00a0and\u00a0Circulation<\/a>, replaces the 2018 cholesterol guideline. The updates reflect advances in cardiovascular risk prediction, lipid testing, and treatment options. A central theme is identifying and treating elevated cholesterol at a younger age to reduce cumulative exposure to plaque-causing, artery\u2011damaging lipids and lower the risk of atherosclerotic cardiovascular disease (ASCVD), the leading cause of death worldwide.<\/p>\n An estimated 1 in 4 adults in the U.S. has a high level\u00a0of LDL-C, commonly\u00a0known as \u201cbad\u201d cholesterol, which is linked to cardiovascular disease.<\/p>\n Three of UT\u00a0Southwestern\u2019s preventive cardiologists played key roles in the update process.\u00a0Ann Marie Navar, M.D., Ph.D.<\/a>, Associate Professor of\u00a0Internal Medicine<\/a>\u00a0and in the\u00a0Peter O\u2019Donnell Jr. School of Public Health<\/a>, was a member of the Guideline Writing Committee.\u00a0Parag Joshi, M.D.<\/a>, Associate Professor of Internal Medicine in the\u00a0Division of Cardiology<\/a>\u00a0and Medical Director of the Cardiac Rehabilitation Program, was a member of the Peer Review Committee.\u00a0Anand Rohatgi, M.D.<\/a>, Professor of Internal Medicine in the Division of Cardiology, served as co-Chair of the Peer Review Committee.<\/p>\n \u201cClinical trials have continued to show us that lower is better, and we now have multiple therapies beyond statin drugs to lower cholesterol and prevent heart attacks and strokes,\u201d Dr. Navar said. \u201cOur job now is to work to translate these guidelines to practice, to help our patients reach these evidence-based goals.\u201d<\/p>\n Among the most notable changes, the guideline recommends using the newer AHA equations \u2013 Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) \u2013 to estimate 10\u2011year risk starting at age 30. In adults up to age 59, 30-year risk also can be estimated. This approach allows clinicians and patients to consider lifetime risk and supports conversations about lifestyle changes and medication when appropriate.<\/p>\n The guideline also lists treatment targets for LDL-C, with lower goals for those at increasingly higher risk. To prevent a first heart attack or stroke, the LDL-C goal should be less than 100 mg\/dL for people without risk factors. For those at risk for heart disease including those with diabetes or an elevated 10-year risk, the LDL-C goal is below 70 mg\/dL. For those who have already had a heart attack or stroke and are at highest risk of cardiovascular events, the LDL-C goal is below 55 mg\/dL.<\/p>\n The new guidance also expands the role of testing. Coronary artery calcium (CAC) scoring is recommended for borderline or intermediate risk adults who are uncertain about whether to start cholesterol medicine. CAC testing uses a CT scan to identify evidence of cholesterol buildup in the arteries. If any CAC is present, statins are recommended. The guideline also recommends all adults have a lipoprotein(a) [Lp(a)] test at least once in their lifetime. Lp(a) is a type of cholesterol that increases the risk of heart disease but is not detected by traditional cholesterol tests.<\/p>\n Although Lp(a)-lowering therapies are still investigational, the guidelines recommend\u00a0patients\u00a0with a high Lp(a) undergo more intensive cholesterol-lowering.\u00a0Because Lp(a) is mostly determined by genetics and very stable over a lifetime, the test does not need to be repeated. The guideline also provides treatment goals for ApoB, a different way to measure \u201cbad\u201d cholesterol particles that may be more accurate than LDL-C.<\/p>\n \u201cCardiovascular disease remains highly preventable, yet too many people experience heart attacks or strokes before risk is recognized,\u201d Dr. Joshi said. \u201cThese recommendations give clinicians better tools to personalize care and identify patients who may benefit from intervention, particularly younger adults and those with family histories of heart disease.\u201d<\/p>\n Lifestyle modification remains the foundation of cardiovascular disease prevention, including a healthy diet, regular physical activity, weight management, blood pressure control, and tobacco avoidance. For many, lifestyle changes are not enough to reach cholesterol goals, and medications are needed. Statins remain the cornerstone of therapy, with additional medications recommended for certain patients to achieve optimal lipid control. After statins, the guidelines recommend using one of several evidence-based therapies that lower cholesterol to prevent cardiovascular events, including ezetimibe, bempedoic acid, and\u00a0PCSK9\u00a0inhibitors.<\/p>\n \u201cThis guidance reflects a fundamental shift in how we think about cholesterol \u2013 not just as a short\u2011term number, but as a lifelong exposure that shapes cardiovascular risk,\u201d Dr. Rohatgi said. \u201cBy intervening sooner and using better risk assessment tools, we have a real opportunity to prevent disease rather than simply treating it after the fact.\u201d<\/p>\n UT\u00a0Southwestern has been a leader in cholesterol research for decades. In 1985,\u00a0Michael Brown, M.D.<\/a>, and\u00a0Joseph Goldstein, M.D.<\/a>, were awarded the\u00a0Nobel Prize<\/a>\u00a0in Physiology or Medicine for their discovery of the LDL receptor and its role in cholesterol regulation. Their findings led to the development of statins, which revolutionized cardiac preventive care. And findings from the\u00a0Dallas Heart Study<\/a>, a longitudinal study launched by UTSW in 2000, led to the development of a new class of drugs that lowers LDL levels by inhibiting the\u00a0PCSK9\u00a0gene.<\/p>\n