US Dyslipidemia Guidelines
The 2026 US Dyslipidemia Guidelines Have Arrived — and We Aren't Surprised About What They Say
The American College of Cardiology (ACC) and American Heart Association (AHA) released updated guidelines on the management of dyslipidemia last month. While we are confident that the approach to biomarker testing and assessment of risk for atherosclerotic cardiovascular disease (ASCVD) at NiaHealth is grounded in solid evidence, it was heartening (pardon the pun) to see the new guidelines so clearly reaffirm our practice. Having the importance of early screening and tests such as Lp(a), apoB, and hsCRP highlighted by major medical societies is also expected to lead to more widespread use of these tests and increased comfort with the interpretation of results in primary care.
Here are some of the highlights.
Start Lipid Screening Early
The new guidelines recommend lipid testing beginning at age 19, repeated at least every five years — and more frequently for people with additional risk factors. Accompanying messaging from the guidelines committees has emphasized an "earlier is better" approach to screening, and that, when it comes to LDL-C levels, "lower for longer" improves outcomes.
Set LDL-C Goals Based on Risk
Targets for LDL-C are recommended depending on the presence or absence of ASCVD and the risk of future cardiovascular events:
- People with no known ASCVD who are not at high risk of cardiovascular events should aim for an LDL-C of less than 2.6 mmol/L.
- People without ASCVD but at high risk of events should target less than 1.8 mmol/L.
- People with known ASCVD should target an LDL-C of less than 1.4 mmol/L.
Everyone Should Have an Lp(a) Level Checked at Least Once
Lp(a) is a type of cholesterol particle that is similar to LDL and also contributes to the development of atherosclerosis. People with Lp(a) levels above 100–125 nmol/L have a higher risk of developing ASCVD. Lp(a) levels are more than 90% genetically determined, and while we don't currently have good strategies for lowering Lp(a), results from clinical trials are expected later this year which may change this. Right now, the best way to address a high Lp(a) level is to manage other modifiable ASCVD risk factors, such as nutrition, physical activity, smoking, stress, cholesterol, and blood pressure.
Consider ApoB Testing
ApoB is a protein found on cholesterol-carrying particles that are linked to ASCVD risk, including LDL-C, VLDL, and Lp(a). Having an apoB level above 0.8–1.0 g/L indicates increased cardiovascular risk, and knowing your apoB level can help guide management decisions — particularly for people who are already at target for LDL-C and non-HDL cholesterol.
Coronary Artery Calcium Can Help Guide Management
Coronary artery calcium (CAC) is measured by CT scan and provides an indication of calcium build-up in the arteries that supply the heart. It can detect the presence of "silent" heart disease which may not be captured by blood-based biomarkers. The new guidelines suggest that CAC can serve as a "tiebreaker" among people who are at borderline ASCVD risk based on blood tests and risk scores, to help decide whether to start lipid-lowering therapy such as statin medication.
Reproductive History Is Important and Relevant
The guidelines emphasize that reproductive factors influence ASCVD risk and should be factored into decision-making. In particular, the following risk factors should be considered: early menarche, early menopause (before the age of 45), polycystic ovary syndrome, and adverse pregnancy outcomes such as hypertensive disorders of pregnancy, gestational diabetes, and preterm delivery.
Don't Ignore Other Risk-Enhancing Factors
A number of non-traditional risk factors have emerged as strong independent predictors of ASCVD risk, including hsCRP (a marker of inflammation), triglycerides, and polygenic risk scores. The guidelines provide a reminder of the role that these factors play in risk assessment.
Nutrition Matters for Lowering Triglyceride Levels
While lifestyle measures such as nutrition and exercise have a relatively modest effect on LDL-C lowering — around 30% — nutrition in particular can have a substantial impact on triglycerides. The guidelines emphasize that dietary modifications are the mainstay of management for people with high triglyceride levels, and recommend that people with triglycerides above 11.3 mmol/L see a dietitian.
De-Emphasis of Supplement Use
The guidelines provide evidence that supplements — including fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice — don't have a proven role in reducing LDL-C or triglycerides and shouldn't replace lifestyle changes and/or medication for this purpose.
What This Means for NiaHealth Members
These updated guidelines reinforce what has been at the core of our approach at NiaHealth from the start: early, comprehensive screening and a personalized approach to cardiovascular risk. Tests like Lp(a), apoB, and hsCRP — which we already include in our assessments — are now being endorsed even more strongly by the leading cardiology and heart health organizations. If you're a NiaHealth member, you can feel confident that your care is aligned with the latest evidence. And if you haven't yet had these tests done, there's never been a better time to start understanding your cardiovascular risk profile.
Our research standards & process
At NiaHealth, we do not make decisions first and look for evidence later. The entire process — from which tests we offer, to how we interpret results, to the recommendations we make — is grounded in clinical evidence from the ground up. Our research team is continually reviewing the literature to make sure the information we provide reflects current medical evidence. And frankly, we don’t think “trust us” should be the standard here. We think you should be able to see the process for yourself. Learn more here.
