Implications of the 2026 Versus 2018 ACC/AHA Multisociety Dyslipidemia Guidelines on the Clinical Care of U.S. Adults

The American College of Cardiology and American Heart Association recently updated their guidelines for dyslipidemia, which included recommending new risk calculators and thresholds, treatment targets, and treatment recommendations based on long-term risk.

The purpose of this study was to quantify the population-level implications of the 2026 Dyslipidemia Guideline.

Using data across 4 survey cycles from the 2011-2020 NHANES (National Health and Nutrition Examination Survey), we estimated the proportion and number of U.S. adults aged 20 years or older who were eligible for initiation of lipid-lowering therapy (LLT) under the 2026 vs 2018 guideline recommendations and the proportion meeting their 2026 treatment targets RESULTS: Among U.S. adults ≥20 years of age without atherosclerotic cardiovascular disease (ASCVD), with a low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dL, and not on LLT (n = 165.4 million), 40.5% were eligible per the 2026 guideline vs 25.7% per the 2018 guideline, representing an additional 24.5 million adults. The largest contributor to the increase was the recommendation to consider statins in adults aged 30 to 59 years with a 30-year ASCVD risk ≥10% despite a 10-year risk <3%, based on which 15.6 million more adults would be eligible. In this age group, nearly twice as many qualify based on a 30-year ASCVD ≥10% vs 10-year ASCVD risk ≥3% (15.6 million vs 7.9 million). Among 39.1 million adults receiving LLT for a Class 1 indication, most (79.0%) had LDL-C above goal, including 91.1% of adults with ASCVD having LDL-C ≥55 mg/dL and 74.5% with LDL-C ≥70 mg/dL.

Compared with the 2018 guideline, the 2026 American College of Cardiology/American Heart Association Multisociety Dyslipidemia Guideline substantially expanded the proportion of U.S. adults for whom statin therapy should be considered by extending recommendations to adults at high 30-year risk. Among those already on treatment, the vast majority remain above new guideline goals. Significant population-level shifts in statin initiation and therapy intensification will be needed to reach guideline goals at a national level.