Revised lipid-lowering therapy guidelines in a nationally representative sample

Area of Science:

• Cardiology
• Public Health
• Clinical Guidelines

Background:

• The 2026 ACC/AHA dyslipidemia guideline incorporates PREVENT-based risk assessment and new treatment pathways.
• The impact of these guideline changes on lipid-lowering therapy recommendations is not yet understood.

Purpose of the Study:

• To compare patient classification for treatment recommendations under the 2018 and 2026 dyslipidemia guidelines.
• To assess the shift in treatment indications for U.S. adults based on the new guideline.

Main Methods:

• A cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (2013-2023).
• Adults aged 40-75 years were classified according to both 2018 and 2026 guidelines, with separate analysis for those on lipid-lowering therapy.
• Treatment recommendation categories were defined for untreated adults to enable cross-classification.

Main Results:

• The 2026 guideline recommended/indicated treatment for 37.7% of untreated adults (31.2 million), compared to 25.6% (21.2 million) under the 2018 guideline.
• Significant reallocation occurred: 45.5% of those in the 2018 'reasonable' category moved to 'recommended/indicated' in 2026.
• PREVENT-based pathways accounted for 33.4% of individuals recommended for treatment under the 2026 guideline.

Conclusions:

• The 2026 dyslipidemia guideline identifies an additional 15.9 million untreated Americans aged 40-75 years for treatment consideration.
• The updated guideline substantially increases the number of adults considered for lipid-lowering therapy.