2026 Cholesterol Guidelines Tighten LDL Targets and Expand Screening

The 2026 ACC/AHA Dyslipidemia Guideline updates risk assessment with a new PREVENT calculator, reintroduces explicit LDL-C targets (including very low goals for high-risk individuals), and adds universal lipoprotein(a) screening and calcium scoring for intermediate risk. About 1 in 3 Americans without heart disease have LDL above the new goals, and nearly 4 in 5 with a prior cardiovascular event do. Treatment is now driven by overall cardiovascular risk rather than a single LDL number, with options spanning statins to non-statin therapies (ezetimibe, PCSK9 inhibitors, Inclisiran) and the new Lipfrenda, while supplements generally don’t replace proven therapies. The guidelines also flag undertreatment and racial disparities in statin use and emphasize early, personalized risk-based decisions.