- The AHA, ACC, and other medical organizations released new cholesterol guidelines in 2026.
- Three studies evaluated the potential impact of the new guidelines and found that they could expand treatment options.
- With more than half of U.S. adults eligible for statin therapy under the new guidelines, experts say early intervention is key to cholesterol management.
- A comprehensive approach to treating high cholesterol is recommended, including lifestyle changes and medication, if needed.
The new cholesterol guidelines recommend treating high cholesterol earlier, measuring lipoprotein(a) at least once to identify inherited heart disease risk, and using a newer, more personalized calculator to estimate cardiovascular risk.
They also set lower LDL (“bad”) cholesterol targets for people at very high risk of heart disease and encourage tailoring treatment based on individual risk factors and imaging when appropriate.
Now, three studies have examined the potential impact of the guidelines.
Collectively, they found that the changes to the guidelines could expand treatment eligibility and improve cholesterol control among U.S. adults.
A study published in
Researchers evaluated how many adults had LDL cholesterol levels above the 2026 guidelines’ goals, taking into account each person’s heart disease risk.
The findings showed that about one-third of adults without heart disease had LDL cholesterol above recommended levels, with the proportion increasing sharply with higher risk categories:
- 10% among low risk individuals
- 64% among those at borderline or intermediate risk
- 83% among high risk individuals
Among adults with established heart disease, nearly 80% had LDL levels above the stricter targets.
Additionally, the study revealed that a large majority of those with LDL cholesterol above the goal were not receiving cholesterol-lowering medications.
Specifically, over three-quarters of high risk individuals in primary prevention were untreated, and more than one-third of those in secondary prevention (with existing heart disease) were not receiving therapy.
These treatment gaps highlight ongoing challenges in managing cholesterol effectively and preventing cardiovascular events.
A separate analysis published in the same issue of
Statins are a commonly prescribed cholesterol-lowering medication for the primary prevention of heart attack or stroke.
The study found that the new guidelines significantly expand the number of U.S. adults who are recommended statins.
Approximately 56.6% of adults ages 30 to 79 years (about 87.5 million people) are now eligible for statins, including 21.5 million individuals who were not previously recommended statin therapy under the older 2018 guidelines.
The newly eligible group tends to be younger and at lower short-term risk, with an average predicted 10-year heart disease risk of just 3.1%, compared to 6.1% for those previously eligible. This change is partly due to the guidelines’ lowered risk thresholds and the inclusion of 30-year risk estimates for younger adults.
Statin eligibility varied by age: more than 93% of adults ages 70 to 79 and 85% of those ages 60 to 69 qualify for statins, while eligibility is much lower among adults ages 30 to 39 (about 11%).
The study also noted that among the newly eligible, many had other risk factors, such as:
The majority of adults currently taking statins continue to have a clear indication for therapy under the new guidelines, supporting continued treatment.
A third study, also published in
The PREVENT-ASCVD risk tool is recommended over the older Pooled Cohort Equations (PCEs) in the 2026 guidelines.
Using NHANES data from 1999 to 2020, the study included adults ages 40 to 79 years without existing heart disease.
Researchers found that about 21.5% of adults were reclassified into different risk categories when using PREVENT instead of PCEs. Two-thirds of these individuals were moved to a lower-risk category, while one-third were moved to a higher-risk category.
Further, males, non-Hispanic Black individuals, and current smokers were more often reclassified downward, meaning their risk was estimated to be lower with the new tool. On the other hand, females and those with diabetes were more frequently reclassified upward.
Despite these shifts, the overall proportion of adults recommended for cholesterol-lowering therapy remained about the same.
The changes in risk categories allow for more personalized assessment and treatment decisions, including greater use of additional tests like coronary artery calcium scoring and consideration of risk-enhancing factors.
Alexander Gutierrez, lead cardiac sonographer and department supervisor at Palmetto General Hospital in South Florida, and the founder of NightShiftQuant, said the 2026 guidelines present meaningful shifts in cholesterol management.
Specifically, he cited the restoration of specific LDL cholesterol targets and the recommendation on universal Lp(a) screening. Gutierrez wasn’t involved in the studies.
Elevated Lp(a) is one of the most underdiagnosed drivers of premature cardiovascular disease, according to Gutierrez, who also praised the fact that children are now being addressed by the guidelines.
“[F]amilial hypercholesterolemia starts at birth, and catching it early is where imaging and lipid screening intersect most powerfully,” he said.
Gutierrez further noted that many people may not realize they have high cholesterol.
“Patients feel fine until they don’t — and often the first time they truly understand their risk is when I am showing them their own heart on a screen,” he said, noting that this makes early intervention especially valuable.
Sonal Chandra, MD, a preventive cardiologist and founder of Focus Cardiology, said that cholesterol should never be treated as a single lab value. Chandra wasn’t involved in the studies.
“Cardiovascular risk has always been a composite of multiple factors, including age, blood pressure, diabetes, kidney function, smoking, family history, cumulative exposure to elevated cholesterol, and evidence of existing plaque,” she told Healthline.
However, the emphasis on numbers among the general public has sometimes distracted from this.
“The updated guidelines are helpful because they formally reinforce a more comprehensive approach, but they are also catching up to what many patients and clinicians have understood for years: cardiovascular prevention requires treating the whole risk profile, not simply chasing one cholesterol number,” said Chandra.
Chandra noted the importance of employing both lifestyle measures and, if needed, medication to treat elevated cholesterol.
However, medication may still be necessary for some, even after following these recommendations.
“The decision should be thoughtful, individualized, and based on the patient’s overall cardiovascular risk, evidence of existing plaque, treatment goals, and personal preferences,” said Chandra.
Leave a Reply