Fernando Vidal-Ostos De Lara

2026 Dyslipidemia Guidelines: Key Updates in Cardiovascular Prevention On March 13, 2026, the ACC/AHA Multisociety Guideline on the Management of Dyslipidemia was released, replacing the 2018 cholesterol guideline. The update broadens the focus from cholesterol alone to overall dyslipidemia, including LDL-C, triglycerides, and emerging markers like lipoprotein(a), with a central goal: earlier and more personalized prevention of ASCVD. Major Highlights 1. New Risk Calculator The PREVENT-ASCVD risk equation replaces the older pooled cohort equations for adults 30–79. It often estimates lower and more accurate risk, and also introduces 30-year risk assessment for younger adults. 2. LDL-C Targets Return Clear lipid goals are reintroduced: •<100 mg/dL for borderline/intermediate risk •<70 mg/dL for high risk •<55 mg/dL for very high risk The principle: “lower for longer” to reduce lifetime exposure to atherogenic lipids. 3. Routine Lp(a) Testing For the first time, Lp(a) measurement at least once in a lifetime is recommended for all adults to identify genetic cardiovascular risk. 4. Greater Role for CAC Scoring Coronary artery calcium (CAC) scoring is emphasized for decision-making. A CAC score of 0 may delay statins, while higher scores strongly support treatment. 5. Earlier and Broader Treatment Statins and other therapies (ezetimibe, PCSK9 inhibitors, bempedoic acid, inclisiran) are recommended earlier in high-risk individuals, including those with diabetes, CKD, or strong family history. 6. Lifestyle Still Comes First Healthy diet patterns, regular physical activity, and weight control remain the foundation of dyslipidemia management. The Big Picture The 2026 guideline emphasizes earlier risk detection, lower lipid targets, and lifelong prevention—aiming to reduce cumulative lipid exposure and ultimately prevent atherosclerotic cardiovascular disease before it develops.