JACC
New ACC/AHA dyslipidemia guideline shifts prevention earlier, endorses PREVENT risk model
The 2026 ACC/AHA multisociety guideline introduces major changes to primary prevention, now strongly recommending the PREVENT‑ASCVD equations for adults ages 30 to 79 without known ASCVD or subclinical atherosclerosis and with LDL-C 70 to 189 mg/dL. PREVENT’s more accurate, lower estimates mean a 10‑year risk ≥3% is now the point to begin considering lipid‑lowering therapy—roughly equivalent to the former 7.5% Pooled Cohort Equations threshold. Borderline‑risk patients (3% to <5%) should be evaluated for risk enhancers including premature family history, higher‑risk ancestry, elevated hs‑CRP, polygenic risk, high triglycerides, and Lp(a) ≥125 nmol/L.
The guideline also expands biomarker use: measure Lp(a) once in all adults (class I), obtain a non-contrast coronary artery calcium (CAC) scan when treatment remains uncertain (class I), and consider measuring ApoB in patients meeting LDL/non–HDL targets but with residual risk (class IIa). CAC >0—especially ≥100—supports starting therapy, with LDL goals of <70 mg/dL for CAC ≥100 and optionally <55 mg/dL for CAC ≥300.
Therapeutic options broaden as ezetimibe, PCSK9 monoclonal antibody, and bempedoic acid receive class I endorsement as add-ons for severe hypercholesterolemia, while dietary supplements are discouraged.
Source:
Blumenthal R.S., et al. (2026, March 13). JACC. 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. https://www.jacc.org/doi/10.1016/j.jacc.2025.11.016