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Updated: Aug 6, 2026

Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Projected impact of 2026 ACC/AHA/Multisociety Dyslipidemia Guideline on lipid-lowering therapy eligibility based on
Sameer A Sidiq1, Geoffrey Y Zhang1, Dmitry Abramov2
1Department of Medicine, Baylor College of Medicine, Houston, TX, United States (Sidiq and Zhang).
Background:
The 2026 American College of Cardiology/American Heart Association/Multisociety Dyslipidemia Guideline introduced pivotal changes to lipid-lowering therapy (LLT) eligibility compared with the 2018 Guideline.
Objective:
We aimed to compare eligibility for Class 1 and 2a LLT indications in the United States between the 2018 and 2026 Dyslipidemia Guidelines.
Methods:
We utilized National Health and Nutrition Examination Survey 2011-2018 datato evaluate LLT eligibility among participants aged ≥20 years, excluding pregnant women. Population weighted estimates were generated by indication and by demographic characteristic.
Results:
Under the 2026 Guideline, 102.9 million adults (46.8%, 95% CI: 45.0-48.6) would be eligible for LLT, including 65.3 million (29.7%, 95% CI: 28.0-31.4) with a Class 1 indication and 37.6 million (17.1%, 95% CI: 15.8-18.4) with a Class 2a indication, compared with 65.3 million adults (29.7%, 95% CI: 28.1-31.3) under the 2018 Guideline, including 60.2 million (27.4%, 95% CI: 25.8-28.9) and 5.1 million (2.3%, 95% CI: 2.0-2.7), respectively. The increase in eligibility was primarily driven by 2 additional Class 2a indications introduced in the 2026 Guideline: individuals with borderline Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) risk (previously classified as Class 2b) and adults aged 30 to 59 years with low PREVENT risk but elevated low-density lipoprotein cholesterol or elevated 30-year atherosclerotic cardiovascular disease risk.
Conclusion:
Future studies should assess whether expanded eligibility improves LLT use and cardiovascular outcomes.
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