The short version
In March 2026 the American College of Cardiology (ACC) and American Heart Association (AHA) replaced their 2018 cholesterol guideline. The four changes most likely to affect you: LDL goals are back (as low as under 55 mg/dL / 1.4 mmol/L for the highest-risk people), a new risk calculator called PREVENT decides who's offered treatment, every adult should have Lp(a) measured once, and ApoB and calcium scans are used to fine-tune risk for some people.
This is general information, not medical advice
Guidelines are written for doctors and describe what they should consider, not what any one person must do. Your own goals depend on your history, other conditions and overall risk. Don't start, stop or change any medicine because of something you read here. Take your questions to your doctor.
What the new guideline is
The full name is the 2026 ACC/AHA Guideline on the Management of Dyslipidemia, published on 13 March 2026 in the Journal of the American College of Cardiology and Circulation. Nine other US professional groups signed up to it, including the American Diabetes Association and the National Lipid Association. It was led by cardiologists Roger Blumenthal and Pamela Morris, and covers evidence up to late 2024.
The name change is a clue to what's new. The 2018 version was about "blood cholesterol". The 2026 version is about "dyslipidemia", meaning any unhealthy pattern of blood fats. That reflects a broader view that LDL isn't the only particle that matters: triglyceride-rich particles and Lp(a) count too.
It's a US guideline. If you're in the UK, your GP follows NICE guidance instead, which we cover further down.
The main changes
1. LDL goals are back
The 2018 guideline moved away from fixed LDL targets. It focused instead on the right strength of statin and on how much your LDL fell in percentage terms. The 2026 guideline keeps the percentage drops but brings back numeric goals for LDL and non-HDL cholesterol, with lower goals for higher-risk groups. For people being treated:
| Your situation | LDL goal | Non-HDL goal |
|---|---|---|
| Heart or artery disease at very high risk | Under 55 mg/dL (1.4 mmol/L) | Under 85 mg/dL (2.2 mmol/L) |
| Heart or artery disease, not very high risk | Under 70 mg/dL (1.8 mmol/L) | Under 100 mg/dL (2.6 mmol/L) |
| No heart disease, high 10-year risk (PREVENT 10% or more), or diabetes with several other risk factors | Under 70 mg/dL (1.8 mmol/L) | Under 100 mg/dL (2.6 mmol/L) |
| No heart disease, borderline or intermediate risk (PREVENT 3% to under 10%) and taking a statin, or diabetes aged 40 to 75 | Under 100 mg/dL (2.6 mmol/L) | Under 130 mg/dL (3.4 mmol/L) |
"Very high risk" has a specific meaning: two or more major events (a heart attack or unstable angina in the past year, an earlier heart attack, an ischaemic stroke, or peripheral artery disease with symptoms), or one major event plus at least two high-risk features like being 65 or older, diabetes, high blood pressure, smoking, heart failure, or a previous stent or bypass. The guideline expects most people who've had a heart attack or stroke to fall into this group.
For a fuller explanation of where your own numbers sit, see how to read your cholesterol test results.
2. A new risk calculator: PREVENT
For people without heart disease, the decision about whether to offer a statin depends on estimated risk. The 2026 guideline swaps the old Pooled Cohort Equations for the AHA's newer PREVENT equations. PREVENT estimates your chance of a heart attack or stroke over the next 10 years (ages 30 to 79) and, for people aged 30 to 59, over the next 30 years. It uses the kind of information collected at a routine check-up: age, blood pressure, cholesterol, kidney function, diabetes and smoking.
| 10-year PREVENT risk | Category | What the guideline suggests |
|---|---|---|
| Under 3% | Low | Focus on healthy habits. A statin is reasonable if LDL is 160–189 mg/dL (4.1–4.9 mmol/L) or 30-year risk is 10% or more |
| 3% to under 5% | Borderline | Consider a statin after a discussion with your doctor, taking risk enhancers like a high Lp(a) or family history into account |
| 5% to under 10% | Intermediate | A statin is recommended |
| 10% or more | High | A high-intensity statin is recommended |
PREVENT generally gives lower risk numbers than the old calculator, so a 5% score today isn't directly comparable with a 5% score from a few years ago. If a doctor quoted you a risk figure before 2026, it was probably from the older tool.
Some groups don't depend on the calculator at all. The guideline recommends LDL-lowering treatment for people with an LDL of 190 mg/dL (4.9 mmol/L) or more, and for adults aged 40 to 75 with diabetes, chronic kidney disease stage 3 or 4, or HIV.
3. An Lp(a) test for every adult
This is the change most people can act on straight away. The guideline says Lp(a) should be measured at least once in every adult. Lp(a), or lipoprotein(a), is a cholesterol-carrying particle whose level is mostly inherited. Diet and exercise barely move it, and it stays fairly stable through life, so one test is usually enough.
- 125 nmol/L (50 mg/dL) or more: counts as a "risk-enhancing factor", linked to about 1.4 times the risk of heart attack and stroke.
- 250 nmol/L (100 mg/dL) or more: linked to about twice the risk or more.
A high result doesn't mean you're ill. It's a reason for your doctor to push harder on LDL and other risk factors, and for close relatives to consider getting tested too. Lp(a) isn't part of a standard cholesterol test, so if you've never had it checked, ask. Our guide to the Lp(a) test explains what your result means and how to request it.
4. ApoB for some people
ApoB (apolipoprotein B) counts the number of plaque-forming particles in your blood rather than the cholesterol they carry. The guideline stops short of making it routine. It says ApoB is reasonable for people already on treatment, especially with heart disease, type 2 diabetes, metabolic problems or high triglycerides, to check whether there's risk left over once LDL and non-HDL goals are met. It may also help some people who aren't on treatment yet.
5. Checking earlier and acting earlier
The guideline puts more weight on how long your arteries are exposed to high cholesterol, not just how high it is at one point. In practice that means:
- A lipid panel for every adult from age 19, and at least every 5 years after that, more often if you have risk factors.
- A cholesterol check for children aged 9 to 11 who haven't been tested, mainly to spot inherited high cholesterol.
- Earlier discussion of treatment for young adults with an LDL of 160 mg/dL (4.1 mmol/L) or more, or a strong family history of early heart disease.
6. Calcium scans to settle uncertain cases
A coronary artery calcium (CAC) scan is a quick CT scan that shows calcified plaque in the heart's arteries. The guideline suggests it for men from 40 and women from 45 when the decision about starting treatment isn't clear. A score of zero can support holding off for a few years; a higher score can mean starting treatment or aiming for a lower LDL.
7. Food first, supplements not recommended
Diet and lifestyle are still the foundation for everyone. The guideline's patient messages recommend an eating pattern built on vegetables, fruit, whole grains, beans, nuts, seeds, unsaturated fats and lean protein, and limiting ultra-processed foods high in saturated fat, added sugar and salt. They also cover a healthy weight, regular activity, not smoking, and 7 to 9 hours of sleep. What's new is a clear line on supplements: the guideline doesn't recommend dietary supplements for lowering LDL or triglycerides, because the evidence is limited and inconsistent.
8. More medicine options
Statins are still the first-line treatment. The guideline adds clearer guidance on what to add when a statin alone doesn't reach the goal or isn't tolerated, covering several newer medicines approved since 2018. If you've had side effects on a statin, it's worth knowing there are now more alternatives to discuss.
What it means for you
- If you've never had a heart attack or stroke: ask what your PREVENT risk is and whether you've had Lp(a) measured. Those two answers shape most of what the guideline suggests for you.
- If you're already on a statin: ask whether you have an LDL goal now, and what it is. Under the 2018 guideline you may only have been told your LDL had dropped enough in percentage terms.
- If you've had a heart attack, stroke or stent: your goal is likely under 55 mg/dL (1.4 mmol/L), lower than many people were aiming for before. If you're not there yet, ask whether adding another medicine makes sense.
- If high cholesterol or early heart disease runs in your family: an Lp(a) test and a full lipid panel are a sensible starting point, for you and for close relatives.
- Whatever your risk: the food and lifestyle advice hasn't changed. Saturated fat, fibre and weight still move your LDL. See how to lower cholesterol naturally for where to start.
What hasn't changed
- LDL is still the main target, and lower is better for people at higher risk.
- The healthy ranges on a lab report (for example, LDL under 100 mg/dL / 2.6 mmol/L as "optimal") are the same. Goals only matter once you and your doctor have agreed on treatment.
- Statins are still the first medicine most people are offered.
- A fasting or non-fasting test is fine for a routine check.
- Healthy eating, activity and not smoking matter for everyone, whatever their numbers.
If you're in the UK
The US guideline doesn't change NHS practice. NICE guidance (NG238) still applies. It uses the QRISK3 calculator, offers a statin when 10-year risk is 10% or more, and aims for a fall of more than 40% in non-HDL cholesterol for people taking a statin to prevent a first heart attack or stroke. For people who already have heart or artery disease, NICE aims for LDL of 2.0 mmol/L or less, or non-HDL of 2.6 mmol/L or less. The US guideline is still useful background, especially the Lp(a) advice, and it's reasonable to ask your GP about it.
Questions to take to your next appointment
- Do I have an LDL or non-HDL goal, and what is it?
- What is my 10-year risk (PREVENT in the US, QRISK3 in the UK)?
- Have I ever had Lp(a) measured? Should I?
- Would an ApoB test or a calcium scan change anything for me?
- How much could diet changes move my LDL before we consider medicine, and when should I re-test?
Tracking against a goal
Having a numeric goal again makes tracking more useful. Logging each lipid panel with its date lets you and your doctor see how far you are from your goal and whether the trend is heading the right way, rather than judging from one result.
Sources
- Blumenthal RS, Morris PB, et al. 2026 ACC/
AHA/ . J Am Coll Cardiol. 2026;87(19). Also published in Circulation, doi:10.1161/CIR.0000000000001423.AACVPR/ ABC/ ACPM/ ADA/ AGS/ APhA/ ASPC/ NLA/ PCNA Guideline on the Management of Dyslipidemia - American Heart Association: 2026 Guideline on the Management of Dyslipidemia (overview, top things to know, key patient messages)
- NICE NG238: Cardiovascular disease risk assessment and reduction, including lipid modification
Frequently asked questions
What are the new cholesterol guidelines for 2026?
In March 2026 the American College of Cardiology and American Heart Association published the 2026 Guideline on the Management of Dyslipidemia, replacing their 2018 cholesterol guideline. The main changes: LDL and non-HDL goals are back, a new PREVENT calculator estimates heart risk, every adult should have Lp(a) measured at least once, and ApoB and coronary calcium scans are used more selectively to refine risk.
What is the new LDL goal in 2026?
It depends on your risk. For people on treatment, the 2026 ACC/AHA guideline sets an LDL goal of under 55 mg/dL (1.4 mmol/L) for people with heart disease at very high risk; under 70 mg/dL (1.8 mmol/L) for other people with heart disease or a 10-year PREVENT risk of 10% or more; and under 100 mg/dL (2.6 mmol/L) for people at borderline or intermediate risk who take a statin.
Does everyone need an Lp(a) test now?
The 2026 ACC/AHA guideline recommends measuring Lp(a) at least once in every adult. Levels of 125 nmol/L (50 mg/dL) or more count as a risk-enhancing factor, and 250 nmol/L (100 mg/dL) or more is linked to about twice the risk. Lp(a) is mostly inherited, so one test is usually enough.
What is the PREVENT calculator?
PREVENT is the American Heart Association's risk calculator. The 2026 guideline uses it instead of the older Pooled Cohort Equations to estimate the chance of a heart attack or stroke over 10 years (ages 30 to 79) and 30 years (ages 30 to 59). Risk is grouped as low (under 3%), borderline (3% to under 5%), intermediate (5% to under 10%) or high (10% or more).
Do the 2026 US guidelines apply in the UK?
Not directly. NHS doctors follow NICE guidance, which uses the QRISK3 calculator and, for people who already have heart or artery disease, aims for LDL of 2.0 mmol/L or less or non-HDL of 2.6 mmol/L or less. The US guideline is still useful background, especially on Lp(a).
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