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Understanding the New AHA/ACC dyslipidemia guidelines

The American Heart Association (AHA) and American College of Cardiology (ACC) released new guidelines that update and replace the 2018 Guidelines on the Management of Blood Cholesterol.

The 2026 Guideline on the Management of Dyslipidemia emphasizes earlier screening, lower target lipid goals, and the adoption of the updated Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator that integrates kidney function and blood sugar directly into baseline risk calculations.1

In this article:

Clinical challenge | Why it matters | Ordering recommendations | Interpreting test results | Next steps | Supporting resources

 

Clinical challenge: Evolving guidelines around ASCVD risk assessment

The 2026 guidance calls for earlier risk assessment, more personalized treatment, and renewed emphasis on long-term cardiovascular prevention.

Primary care providers will need to adjust their clinical protocols to accommodate the following AHA and ACC guideline updates that may impact their patients.2

Topic2026 guidelineScreening & testing updates
Age and primary preventionAge 9-11: One-time universal lipid screening in high-risk families
Age 19: First adult lipid screening (if normal, repeat every 5 years)
Age 30: Lifetime risk assessment checkpoint using PREVENT		Emphasizes earlier detection and lifetime risk
Lp(a)Everyone should have Lp(a) measured at least once in their lifetime.New universal testing recommendation
ApoBPatients with risk factors for cardiometabolic disease can benefit from apoB testing.New testing recommendation for at-risk patients
Inflammatory markersInflammatory markers such as hsCRP are considered risk enhancers for ASCVD events, and high-intensity statin therapy is recommended.Greater emphasis on inflammation as part of residual risk
Familial hypercholesterolemia (FH)Greater emphasis on identifying hereditary FH in children of high-risk families or in patients with elevated LDL.FH previously found through very high LDL in adults only
Cardiometabolic comorbiditiesAny cardiometabolic disease increases the risk of heart disease and warrants earlier lipid evaluation in high-risk clinical populations.Previously only diabetes was considered a “risk-enhancing factor,” whereas now other high-risk populations are requiring earlier testing and treatment
PREVENT CalculatorPREVENT calculator should be used beginning at age 30 to estimate a patient’s risk of CVD and guide treatments.Utilize the PREVENT calculator to assess 10- and 30-year risk of heart attack, stroke, and heart failure

Coronary Artery Calcium

(CAC)

CAC should be included in precision risk assessment in men over age 40 and women over age 45.Updated guidelines tie CAC score ranges directly to targeted LDL cholesterol goals and treatment intensity

 

PREVENT risk estimator

The PREVENT equations estimate 10-year and 30-year risk for total CVD, including ASCVD and heart failure. These equations are validated for adults ages 30-79 years without known CVD.

The equations consider attributes such as

  • Sex
  • Age
  • Total and HDL cholesterol
  • Estimated glomerular filtration rate (eGFR)
  • Systolic blood pressure (SBP)
  • Body mass index (BMI)
  • History of diabetes
  • Cigarette smoking
  • Use of lipid-lowering and antihypertensive medication

Optional factors that enhance risk prediction include urine albumin-to-creatinine ratio (uACR), hemoglobin A1c (HbA1C), and the patient’s zip code.

The PREVENT equations should not be used for adults with known CVD, evidence of severe subclinical CVD, positive genetic testing for pathogenic variant or for an inherited cardiovascular condition, end-stage kidney disease, or limited life expectancy (<1 year).3

The AHA has provided an online calculator to help clinicians determine PREVENT risk results in their patients.

The AHA has provided an online calculator to help clinicians determine PREVENT risk results in their patients.

Use calculator

 

Why it matters: Lowering the threshold for testing and treatment

These updated guidelines recommend lower risk thresholds for initiating lipid-lowering therapies. This will require new or earlier testing for at-risk populations and updated universal testing guidelines for Lp(a).

The 2026 Guideline on the Management of Dyslipidemia recommends all patients undergo a CVD risk evaluation beginning at age 30. Based on their results, the AHA recommends the following actions.4

Risk categoryPREVENT-ASCVD 10-year risk estimateLipid-lowering therapyStatin intensityLDL-C reduction goal
Low<3%Emphasize lifestyle; consider statin if LDL-C is 160-189 mg/dL or 30-year risk ≥10% (ages 30-59)Moderate 
Borderline3% to <5%Consider statin after discussion with patient and assessment of risk enhancersModerate≥30% to 49% LDL-C reduction; LDL-C <100 mg/dL and non-HDL-C <130 mg/dL
Intermediate5% to <10%Initiate statin therapyModerate to high, depending on where patient falls on the risk range≥30% to 49% LDL-C reduction; ≥50% LDL-C reduction is beneficial in the higher end of risk range; LDL-C <100 mg/dL and non-HDL-C <130 mg/dL
High≥10%Initiate statin therapyHigh≥50% LDL-C reduction; LDL-C <70mg/dL and non-HDL-C <100 mg/dL

Prevalence of high total cholesterol

7%

of US children and adolescents have high total cholesterol5

10%

of adults age 20 or older have high total cholesterol levels5

13%

of non-Hispanic Asian adult men have high cholesterol5

 

Ordering recommendations: Support CVD risk assessment through lab testing

The PREVENT calculator provides 10-year and 30-year risk for total cardiovascular disease to combine cardiovascular, kidney, and metabolic health measures to guide primary prevention-focused treatment decisions.

Additional panels offered by Quest Diagnostics can help further determine patient risk and treatment needs.

Recommended tests

Lipid Panel, Standard

  • Test code: 7600
  • CPT® code: 80061*

Components include Cholesterol, Total [334], Triglycerides [896], HDL Cholesterol [608], LDL-Cholesterol (calculated), Cholesterol/HDL Ratio (calculated), Non-HDL Cholesterol (calculated)

Lipid Panel, Cardio IQ®

  • Test code: 91716
  • CPT code: 80061*

Components include Cardio IQ® Cholesterol, Total [91717], Cardio IQ® HDL Cholesterol [91719], Cardio IQ® Triglycerides [91718], Cardio IQ® Non-HDL and Calculated Components

Lipoprotein (a)

  • Test code: 34604
  • CPT code: 83695*

Cardio IQ® Lipoprotein (a)

  • Test code: 91729
  • CPT code: 83695*

Apolipoprotein B

  • Test code: 5224
  • CPT code: 82172*

Cardio IQ® Apolipoprotein B

  • Test code: 91726
  • CPT code: 82172*

hs-CRP

  • Test code: 10124
  • CPT code: 86141*

Cardio IQ® hs-CRP

  • Test code: 91737
  • CPT code: 86141*

Cardiometabolic Disease Assessment (CMDA) Panel

  • Test code: 14273
  • CPT codes: 80061*, 82172*, 83036*, 83525, 84681, 82570, 82043, 80053, 85049*, 84443*

Components include HbA1c [496], Insulin Resistance Panel with Score [36509], Lipid Panel [7600], ApoB [5224], TSH [899], Kidney Profile [39165], Comprehensive Metabolic Panel with Fibrosis-4 (FIB-4) Index [10372]

Related tests

Additional tests may help identify preexisting, related cardiometabolic disease that increases a patient’s risk of ASCVD.

Cardio IQ® Insulin Resistance Panel with Score

  • Test code: 36509
  • CPT codes: 83525, 84681

Components include Insulin, Intact LC/MS/MS [93103], C-peptide, and calculated IR score

Metabolic Risk Panel

  • Test code: 39447
  • CPT codes: 80061*, 82172*, 83036*, 83525, 84681

Components include Cardio IQ® Cholesterol, Total [91717], Cardio IQ® HDL Cholesterol [91719], Cardio IQ® Triglycerides [91718], Cardio IQ® Non-HDL and Calculated Components, Cardio IQ® Apolipoprotein B [91726], Cardio IQ® Hemoglobin A1c [91732], Insulin, Intact, LC/MS/MS [93103], C-Peptide, LC/MS/MS and IR Score

Kidney Profile

  • Test code: 39165
  • CPT codes: 82043, 82565, 82570

Components include Albumin, random urine with creatinine (6517),

serum creatinine (375) with calculated eGFR

Non-calculated panel components may be ordered individually.

* CPT code is subject to a Medicare Limited Coverage Policy and may require a signed ABN when ordering.

The CPT® codes provided are based on American Medical Association guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

 

Interpreting test results: Understanding optimal cholesterol ranges

Optimal lipid levels typically fall within the following range6:

  • LDL cholesterol: less than 100 mg/dL
  • HDL cholesterol: more than 40 mg/dL for men and more than 50 mg/dL for women
  • Triglycerides: less than 150 mg/dL
  • Total cholesterol: less than 200 mg/dL

Levels that fall outside of these ranges may require additional testing to support accurate risk assessment. For patients with abnormal lipid levels, treatment may be recommended.

 

Next steps: Lifestyle changes and statin therapy for LDL-C reduction

The AHA and ACC guideline changes emphasize earlier intervention for improved patient outcomes. For patients at low risk, lifestyle changes like eating a heart-healthy diet, getting regular exercise, abstaining from smoking, maintaining a healthy weight, and getting enough sleep can help manage cholesterol.7

For patients at higher risk, consult the PREVENT guidelines for the risk-based management of dyslipidemia. Moderate-intensity statin therapy may be recommended for patients with risks as low as 3% with the goal of ≥30% to 49% LDL-C reduction.4

 

Supporting resources

Cardiovascular disease testing web page
Cardiometabolic Disease Assessment panel web page
Clinical value of apoB testing
Assess cardiometabolic disease with 1 panel
Instant insights: Apolipoprotein B
Instant insights: Lipoprotein (a)
Instant insights: hs-CRP in cardiovascular risk
Instant insights: Streamlining cardiometabolic disease assessment
The Cardiometabolic approach: A solution to modern disease risk assessment
Utilizing biomarkers with coronary artery calcium (CAC) for cardiovascular risk

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References

1.American Heart Association. 2026 Guideline on the Management of Dyslipidemia. Updated March 13, 2026. Accessed June 2, 2026. https://professional.heart.org/en/science-news/2026-guideline-on-the-management-of-dyslipidemia

2. Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2026;153(17):1154-1276. doi:10.1161/CIR.0000000000001423

3. American Heart Association. The American Heart Association PREVENT™ Online Calculator. Accessed June 2, 2026. https://professional.heart.org/en/science-news/~/link.aspx?_id=4E9EEB9E365447DBBEC1A835DC0B318E&_z=z

4. American Heart Association. Top take-home messages for clinicians: using PREVENT-ASCVD equations for risk-based lipid management. Updated March 13, 2026. Accessed June 2, 2026. https://professional.heart.org/en/science-news/-/media/731B2098BB23427F9EA8EDDF98E08145.ashx

5. CDC. High cholesterol facts. Published October 24, 2024. Accessed June 2, 2026. https://www.cdc.gov/cholesterol/data-research/facts-stats/index.html

6. NIH. Dyslipidemia. Updated March 4, 2024. Accessed June 3, 2026. https://www.ncbi.nlm.nih.gov/books/NBK560891/

7. American Heart Association. Prevention and treatment of high cholesterol (hyperlipidemia). Last reviewed March 16, 2026. Accessed June 3, 2026. https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia

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