Updated Guidelines on the Management of Dyslipidemia

Lilian White, MD
April 6, 2026

The American College of Cardiology/American Heart Association (ACC/AHA) recently updated its 2018 guidelines on dyslipidemia management. The new guidelines center around the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) app, which has replaced the previously used Pooled Cohorts Equations risk calculator (as we predicted in an earlier AFP Community blog entry). The new guidelines also advocate for broader use of coronary artery calcium (CAC) scoring to inform treatment decisions. Indications for when to consider and manage results from genetic testing and additional lipid markers such as apolipoprotein B and lipoprotein a (L(p)a) are also included. 

The ACC/AHA recommends using the PREVENT app to stratify patients into low (< 3%), borderline (3% to <5%), intermediate (5% to <10%), and high (≥ 10%) 10-year risk of atherosclerotic cardiovascular disease (ASCVD) events. The app was validated in more than 6 million patients 30-79 years of age without known cardiovascular disease with a low-density lipoprotein cholesterol (LDL-C) level of 70 to 189 mg/dL. PREVENT should not be used to risk-stratify persons with a CAC score ≥ 300, a known inherited or pathogenic variant that confers high ASCVD risk, life expectancy < 1 year, or end-stage renal disease. 

For patients at low risk, according to the PREVENT app, counseling regarding healthy lifestyle behaviors is recommended if LDL-C is 160. For patients at low risk with an LDL-C of 160 to 189, a moderate intensity statin may be considered. Additional recommendations based on a patient’s risk using the PREVENT app can be found in the guidelines.

In the 2018 guidelines, CAC scoring was limited to guiding statin initiation in patients at borderline or intermediate risk of ASCVD. As might be expected, the 2026 guideline adds more nuanced recommendations based on a patient’s CAC score to inform treatment decisions. For example, if a patient of borderline or intermediate risk has a CAC score of 0 AU (Agatston units) and does not have high-risk conditions, medication treatment of hyperlipidemia may be deferred, and a repeat CAC score is recommended in 3 to 7 years. 

Genetic testing is recommended in children and adolescents in whom a clinical suspicion of familial hypercholesterolemia is found and also in adults with severe hypercholesterolemia (LCL-C > 190) in whom an obvious secondary condition is not appreciated. 

Additional markers such as high-sensitivity C-reactive protein (hs-CRP), apolipoprotein B, and lipoprotein A to inform treatment are another significant update in the 2026 guidelines. An hs-CRP ≥ 2 mg/L on more than two occasions without an identifiable cause and in a person who is at borderline risk of ASCVD may consider initiating high-intensity statin therapy. 

Of note, 9 of the 33 authors of the 2026 guidelines have relevant financial disclosures to industry.