New Dyslipidemia Guidelines Emphasize LDL-C Targets, Lp(a) Screening for PCPs

The American College of Cardiology (ACC) and the American Heart Association (AHA) have released the 2026 Updated Clinical Guidelines for Dyslipidemia and Cardiovascular Risk Management, establishing a rigorous new framework for primary care physicians (PCPs) to combat atherosclerotic cardiovascular disease (ASCVD).¹

With 1 in 4 US adults currently living with high low-density lipoprotein cholesterol (LDL-C), the updated document emphasizes earlier intervention and the return of specific LDL-C targets.^1,2

A central shift for primary care is the reinstatement of LDL-C and non-HDL-C goals to guide therapy. For primary prevention, PCPs should target an LDL-C of <100 mg/dL for patients at borderline or intermediate risk, and <70 mg/dL for those at high risk. For secondary prevention in very high-risk individuals, the goal is now <55 mg/dL.

The guidelines emphasize "lower is better," supported by clinical trials showing significant event reduction at levels below previous recommendations. Roger Blumenthal, MD, chair of the guideline writing committee, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and the Kenneth J. Pollin professor of cardiology at Johns Hopkins Hospital in Baltimore, noted "lower LDL cholesterol for longer, just like lower blood pressure for longer, results in much greater protection against future heart attack and stroke risk.”

For the first time, the guideline recommends Lipoprotein(a) [Lp(a)] be measured at least once in adulthood. Because Lp(a) is largely genetically determined and remains stable, repeat testing is generally unnecessary. The guidelines recommend PCPS should identify high Lp(a) (≥125 nmol/L or 50 mg/dL), which carries a 1.4-fold increased risk of heart attack or stroke; levels of 250 nmol/L double that risk. While lifestyle changes minimally impact Lp(a), its presence acts as a "risk enhancer," signaling the need for more intensive LDL-C lowering therapy.

The guideline introduces the PREVENT-ASCVD calculator, replacing older equations overestimated risk by up to 50%. Using data from annual physicals including blood pressure and health habits, PCPs can now better personalize risk. If lifestyle and statins fail to reach targets, the guidelines recommend the addition of non-statin therapies like ezetimibe, bempedoic acid, or PCSK9 inhibitors.

The guidelines lay out a clear mandate for PCPs to identify risk earlier, even starting screenings in children aged 9-11 years old to reduce the lifelong burden of ASCVD.

We reached out to Viet Le, PA-C, DMSc, a preventive cardiology and an associate professor of research at Intermountain Health in Salt Lake City, Utah to discuss Lp(a) lowering and guidance surrounding LDL-C targets and their relevance to PCPs.

References:

1. ACC/AHA Issue Updated Guideline for Managing Lipids, Cholesterol. American Heart Association. Published March 13, 2026. Accessed March 17, 2026. https://newsroom.heart.org/news/accaha-issue-updated-guideline-for-managing-lipids-cholesterol
2. Blumenthal RS, Morris PB, Gaudino M, et al. 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. Circulation. Published online March 13, 2026. doi:https://doi.org/10.1161/cir.0000000000001423