2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
1.Treat dyslipidemia earlier to reduce lifetime exposure to atherogenic lipoproteins; start lifestyle counseling in youth and consider early pharmacotherapy in high-risk individuals (e.g., familial hypercholesterolemia or LDL-C ≥160 mg/dL).
2.Use the PREVENT™ risk equations instead of older models to estimate 10- and 30-year ASCVD risk in adults aged 30–79, applying the CPR approach: Calculate risk, Personalize assessment, and Reclassify if needed (e.g., with CAC).
3.Consider LDL-lowering therapy in primary prevention starting at a 10-year risk of 3–5%, and recommend it more strongly at 5–10%, after clinician–patient discussion.
4.LDL-C and non-HDL-C targets are reintroduced, while maintaining focus on percentage LDL reduction based on ASCVD risk.
5.Apolipoprotein B (ApoB) measurement can help detect residual lipoprotein-related risk, especially in patients with high triglycerides, diabetes, or low LDL-C.
6.Measure Lipoprotein(a) at least once; elevated levels significantly increase ASCVD risk and warrant more intensive LDL-lowering strategies.
7.Coronary artery calcium (CAC) scoring can refine risk assessment and treatment decisions, particularly in men ≥40 and women ≥45 years.
8.LDL-lowering therapy is recommended for adults aged 40–75 with diabetes, CKD stage 3–4, or HIV regardless of LDL-C level.
9.In secondary prevention, stricter targets are recommended: LDL-C <55 mg/dL and non-HDL-C <85 mg/dL for very high-risk patients.
10.Statins remain the foundation of therapy, particularly in patients with elevated triglycerides; additional therapies may be needed for severe hypertriglyceridemia to prevent pancreatitis.
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