Updated ACC/AHA Dyslipidemia Guidelines Incorporate LDL-C Goals, Lp(a) Focus, With Deepak Bhatt, MD, MPH

On March 13, 2026, the American College of Cardiology (ACC) and American Heart Association (AHA) released an updated clinical guideline for the management of 

, replacing the 2018 Guideline on the Management of Blood Cholesterol.

Among some of the most significant changes, the new guidelines encourage clinicians to enhance their focus on lipoprotein(a), or Lp(a). This updated version suggests clinicians measure Lp(a) ≥1 time in all adults when addressing 

atherosclerotic cardiovascular disease (ASCVD) 

risk. This suggestion is now a Class of Recommendation (COR) 1 suggestion.

“I’ve been a believer in measuring Lp(a) for a long time, way before it was in vogue. I used to test it in patients who came in with premature MI,” Deepak Bhatt, MD, MPH, director of Mount Sinai Fuster Heart Hospital and the Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai, told 

 in an exclusive interview. “I think one can debate the exact level of evidence – we’re all eagerly awaiting, probably later this year, the first randomized clinical trials looking at Lp(a) drugs. If those trials are positive, that validates that specific therapeutics lowering Lp(a) as clinically useful.”

Additionally, the 2026 guidelines have shifted from percent reduction of LDL-C back to specific, targeted goals. The previous 2018 version introduced the use of percent LDL-C reductions as a method of monitoring lipid levels and guiding lipid-lowering therapy (LLT). This method was widely considered vague, as these percentages were inherently subjective between patients. Goals, however, establish concrete targets. Although percentage risk reduction in LDL-C was retained as a priority for individuals, LDL-C and non-HDL-C treatment goals are reclaiming their spot as the backbone of LLT guidance.

Specific goals are determined by PREVENT risk tier, with those at borderline risk – between 3 and <5% - having a goal LDL-C of <100 mg/dL and a goal non-HDL-C of <130 mg/dL. Those at intermediate risk – 5 to <10% - have a goal LDL-C of <100 mg/dL, while those at high risk - ≥10% - have a goal LDL-C of <70 mg/dL and a non-HDL-C goal of <100 mg/dL.

Secondary prevention also incorporates LDL-C goals based on these new guidelines; those with high risk, defined as ≥2 major ASCVD events or 1 event and ≥2 high-risk features have a goal LDL-C of <55 mg/dL and non-HDL-C <85 mg/dL. These patients should also receive ezetimibe in addition to maximum tolerated statin. However, those not at very high risk have an LDL-C goal of <70 mg/dL and non-HDL-C of <100 mg/dL.

“I do like the fact that targets are clearly back in the guidelines,” Bhatt said. “That was a real backward step some years ago when the guidelines eliminated targets for LDL. It’s a good illustration of the fact that the guidelines are not always sacrosanct. If you look at different times and places, guidelines have made mistakes. They don’t replace good clinical judgment or individualized patient care.”

Editors’ Note: Bhatt reports disclosures with GSK, Merck, Cereno Scientific, Angiowave, Boehringer Ingelheim, Novo Nordisk, and others.

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. Published online March 13, 2026. 

Livingston R. AHA/ACC Dyslipidemia Guidelines Reinstate LDL-C Goals, With Viet Le, DMSc, PA-C. 

. March 17, 2026. Accessed March 25, 2026. 

https://www.hcplive.com/view/aha-acc-dyslipidemia-guidelines-reinstate-ldl-c-goals-with-viet-le-dmsc-pa-c

Videos

Bhatt shares his thoughts on the recently released dyslipidemia guidelines, highlighting the return of goal-based LDL-C therapy and Lp(a) receiving a COR 1 suggestion.

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Dyslipidemia

Atherosclerotic Cardiovascular Disease

Strategic Alliance Partnership

Allergist-immunologist at Yale New Haven Hospital

The Case for Delabeling NNAALs in Obstetric Care, With Chang Su, MD

Non-narcotic analgesics allergy labels (NNAAL) significantly elevated rates of eclampsia (aRR, 1.5; 95% CI, 1.06–2.12), preterm birth (aRR, 1.21; 95% CI, 1.14–1.28), NICU admission (aRR, 1.17; 95% CI, 1.10–1.25), and neonatal withdrawal syndrome (aRR, 1.51; 95% CI, 1.24–1.84) among labeled mothers across 2,244,210 California singleton livebirths — point toward a clear intervention target: the family planning stage, before pregnancy makes formal drug challenge testing contraindicated.

American Academy of Allergy, Asthma & Immunology (AAAAI)

 2026 Annual Meeting held in Philadelphia, Pennsylvania, from February 27 to March 2, Chang Su, MD, allergist-immunologist at Yale New Haven Hospital outlined why timing matters enormously for NNAAL de-labeling efforts. Evaluating a prior ibuprofen reaction, for example, ideally requires a provocation challenge — which is contraindicated during pregnancy. Waiting until a patient is already pregnant to initiate drug allergy evaluation therefore forecloses the most definitive diagnostic pathway. Su's preferred model is pre-conception referral, integrated into routine family planning screening by OB-GYN and cardiology colleagues, so that allergy status is clarified before it becomes clinically urgent. She described active efforts to work NSAID allergy screening into standard documentation templates and electronic health record workflows used by APPs and physicians in OB practices at her institution — a structural intervention designed to normalize proactive referral rather than relying on reactive, crisis-driven evaluation.

Su also used the final portion of the conversation to reframe how the field should think about drug allergy labels more broadly. NNAALs affect approximately 2% of the population — rarer than beta-lactam labels, which appear in roughly 10% of charts, and therefore harder to study at scale. The study does not overturn existing paradigms around allergy labeling, Su acknowledged, but it extends the known harms of inappropriate labels from beta-lactams into the NSAID class, and makes it easier to extrapolate that other inaccurate allergy labels likely carry similar outcome consequences. Her broader call to action was cultural as much as clinical: rather than entering a blank medication allergy into the chart, clinicians should document the specific reaction type, severity, and any confirmed tolerability thresholds — information that allows downstream providers to make nuanced decisions rather than defaulting to broad avoidance. As Su put it, allergy labels are not a single entity, and the field is increasingly recognizing that indiscriminate labeling carries real repercussions, particularly when it walls patients off from first-line therapies tied to the best outcomes.

Su has no relevant disclosures to report.

1. Su C, Baer R, Otani I, Schatz M, Chambers C. The relationship between maternal non-narcotic analgesics allergy labels and maternal and fetal outcomes: results from a large, administrative cohort. Presented at: AAAAI 2026 Annual Meeting, February 27-March 2, Philadelphia, Pennsylvania. Abstract #L24

2. Non-Narcotic Analgesics Allergy Labels Linked to Adverse Maternal and Fetal Outcomes. News release. AAAAI. February 26, 2026. 

https://www.aaaai.org/about/news/news/2026/narcotic

Su emphasized how care should be shifted to reflect known impacts of NNAALs on obstetric care.

Allergy

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Andres Gelrud, MD, is a gastroenterologist at Baptist Health Miami Cancer Institute, part of Baptist Health South Florida

Why Exocrine Pancreatic Insufficiency Is Frequently Underdiagnosed, With Andres Gelrud, MD

 remains underdiagnosed and undertreated, but improving awareness could help address persistent gaps in clinical care.

Many clinicians and patients remain unaware of EPI’s strong association with diabetes and other pancreatic diseases, contributing to delays in diagnosis.

“Exocrine pancreatic insufficiency is a condition that is caused by multiple reasons, but mainly inadequate production of pancreatic enzymes,” said Andres Gelrud, MD, a gastroenterologist at Baptist Health Miami Cancer Institute, part of Baptist Health South Florida, in an interview with HCPLive. “It’s also defined as inadequate delivery or activity of the pancreatic enzymes needed for normal digestion, and here we’re talking about lipase, protease, and amylase.”

EPI results from inadequate secretion and/or delivery of pancreatic enzymes and bicarbonate into the duodenum, impairing normal digestion. Disruption of acinar cell function, reduced enzyme output, or ductal obstruction limits the availability of key digestive enzymes, including lipase, protease, and amylase. Lipase activity is typically affected earliest, leading to impaired fat digestion before carbohydrate and protein malabsorption. This progressive enzyme deficiency underlies the characteristic features of maldigestion and nutrient malabsorption seen in EPI.

The likelihood of developing EPI is increased in high-risk populations. Among patients with chronic pancreatitis, approximately 60%–90% develop EPI. Prevalence is also high in cystic fibrosis (~85%) and pancreatic cancer (66%–92%), with additional risk observed following pancreatic or bariatric surgery.

Symptoms of EPI are often nonspecific and overlap with other gastrointestinal conditions, including irritable bowel syndrome, inflammatory bowel disease, celiac disease, and small intestinal bacterial overgrowth. Despite this, fewer than 7% of patients with chronic pancreatitis or pancreatic cancer are tested for EPI. As a result, clinicians should remain alert to symptoms such as bloating, diarrhea, and unexplained weight loss.

“If the patient tells you that they have gas, bloating, soft bowel movements, but they’re losing weight, that weight loss should be a major red flag that something is going on,” Gelrud said.

Ruling out EPI in these cases is critical, particularly among patients who report planning meals around anticipated bowel movements. By the time classic symptoms such as steatorrhea emerge, severe pancreatic dysfunction, often reflecting up to 90% loss of exocrine function, may already be present.

To learn more about diagnostic tools for EPI, follow part 2 of this interview.

Editor’s Note: Gelrud reports no relevant disclosures.

de Rijk FEM, van Veldhuisen CL, Besselink MG, et al. Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study. 

https://doi.org/10.1016/j.pan.2022.03.013

Ghodeif AO, Azer SA. Pancreatic Insufficiency. PubMed. Published 2023. 

https://www.ncbi.nlm.nih.gov/books/NBK555926/

Gerlud explains why exocrine pancreatic insufficiency is often missed, even in high-risk patients. 


Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

Piotr Witkowski, MD, PhD, is a professor of surgery in the Transplantation Institute at the University of Chicago.

Tegoprubart Improves Glycemic Control Following Islet Transplantation for T1D, With Piotr Witkowski, MD, PhD

On March 16, 2026, Eledon Pharmaceuticals announced updated results from an investigator-initiated trial of the investigative anti-CD40L monoclonal antibody tegoprubart in patients undergoing allogeneic islet transplant for long-standing 

Advanced Technologies and Treatments for Diabetes (ATTD)

 conference in Barcelona, Spain, from March 11-14, 2026, these data build on previously released data highlighting the drug’s efficacy in both immunosuppression and insulin independence at 4 weeks post-transplant.

Pancreatic islet transplantation is a minimally invasive procedure created to provide blood glucose control in T1D while minimizing insulin dependence. Clinicians isolate pancreatic islets containing insulin-producing beta cells from the pancreas of an organ donor and infuse these cells into the liver via a small catheter. The cells then lodge in small blood vessels in the liver and produce insulin.

“The patient still needs to take anti-rejection immunosuppression medication following implantation,” Piotr Witkowski, MD, PhD, professor of surgery in the Transplantation Institute at the University of Chicago, told 

 in an exclusive interview. “However, the toxicity of this immunosuppression medication has been a major barrier to this therapy; to that end, we have been testing a new medication, tegoprubart, and the results are really promising, with almost no toxicity.”

Tegoprubart is a humanized monoclonal antibody designed to selectively inhibit CD40 ligand, a co-stimulatory molecule in T cell activation. In addition to islet transplantation, tegoprubart is currently being explored for kidney allograft transplantation, xenotransplantation, liver allograft transplantation, and amyotrophic lateral sclerosis.

This pilot study investigated a total of 12 adults with long-standing T1D who underwent allogeneic islet transplant at UChicago Medicine. These patients had a median T1D duration of roughly 33 years and a mean hemoglobin A1c of roughly 8% before transplantation. Participants were given tegoprubart as part of a calcineurin inhibitor-free immunosuppression regimen.

Ultimately, Witkowski and colleagues saw rapid improvement in glycemic control after transplantation. Stable islet graft function was observed across the cohort, with all 10 patients who were >4 weeks post-transplant achieving both insulin independence and a most recent HbA1c of <6%. Among those 10 patients, the mean most recent HbA1c was roughly 5.35%.

Tegoprubart-based immunosuppression was largely well-tolerated during the trial, with reported adverse events successfully treated through lowering of the mycophenolic acid dose where necessary. Additionally, investigators reported no rejection episodes, and no patients developed de novo donor-specific HLA antibodies. No evidence of nephrotoxicity, hypertension, or neurotoxicity, all of which are commonly associated with tacrolimus-based immunosuppression regimens, was observed.

These advancements are particularly significant because patients with T1D in America have limited access to islet transplantation therapy. Current guidelines refer to human islets as a drug rather than an organ for transplantation, meaning they are regulated by the US Food and Drug Administration (FDA) rather than the Health Resources and Services Administration (HRSA). This means that islets currently require a stringent Biologics License Application (BLA).

“One key point I would like to add is that, although we’ve been optimizing islet transplantation for over 20 years, it is still not available to patients with T1D in the US because of outdated regulations,” Witkowski said. “And we, as a transplant community, experts in the field, are advocating for a regulatory update, so that we can help more patients and progress the field faster.”

Eledon Pharmaceuticals. Eledon Announces Updated Data from Investigator-Initiated Islet Transplant Trial of Tegoprubart in Patients with Type 1 Diabetes at UChicago Medicine. March 16, 2026. Accessed March 24, 2026. 

https://ir.eledon.com/news-releases/news-release-details/eledon-announces-updated-data-investigator-initiated-islet

Brooks A. Tegoprubart Enables Insulin Independence in Type 1 Diabetes Islet Transplantation Study. 

. March 16, 2026. Accessed March 24, 2026. 

https://www.hcplive.com/view/tegoprubart-enables-insulin-independence-in-type-1-diabetes-islet-transplant-study

Witkowski discusses the data presented at ATTD 2026, highlighting the investigative anti-CD40L monoclonal antibody in facilitating insulin independence.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Type 1 Diabetes

Julia W. Angkeow, a PhD candidate and former research technologist at Johns Hopkins Medicine

IgG Reactivity Patterns in Pediatric Food Allergy, With Julia Angkeow

New findings suggest that immunoglobulin G (IgG) responses may provide mechanistic insight into pediatric

 with children with peanut and egg allergies showing increased IgG reactivity to food allergen peptides in early childhood.

The analysis, conducted using Phage ImmunoPrecipitation Sequencing (PhIP-Seq), included 458 children from the Boston Birth Cohort. Among them were 80 children with food allergies, 151 with sensitization, and 227 non-allergic controls. Investigators profiled IgG responses to thousands of peptide epitopes at birth and in early childhood.

Compared to controls, peanut-allergic children had greater IgG reactivity to 24 peanut peptides, and egg-allergic children had greater IgG reactivity to 17 egg peptides. These differences were not observed in cord blood, suggesting that postnatal immune development plays a central role.

The study showed modest correlations between IgE and IgG measurements for peanut (

 =.034) in peanut-allergic children, for egg (

 =.24) in egg-allergic children, and for wheat (

 < 0.01) in children with any food allergy.

“These modest correlations suggest that IGE and IgG are partially related, but they're distinct parts of the immune response,” Julia W. Angkeow, a PhD candidate at the Washington University School of Medicine in St. Louis and former research technologist at Johns Hopkins Medicine, told 

 “PhIP-Seq captures all IgG subclasses, which reflects…a broader antigen exposure and immune memory.”

Milk allergy presented a distinct pattern. Lower IgG reactivity to 8 milk peptides was observed in cord blood among children who later developed milk allergy, alongside reduced IgG responses to enteroviral peptides in childhood (all FDR <0.05). These findings may reflect altered early immune priming and are consistent with aspects of the hygiene hypothesis, although causality has not been established.

Angkeow cautioned that IgG profiling, particularly via PhIP-Seq, is not intended for clinical diagnosis of food allergy. Instead, the technology provides a high-throughput, low-cost method for mapping epitope-level immune responses across thousands of antigens simultaneously, thereby far exceeding the scope of conventional ELISA assays. Epitope-level IgG profiling may help differentiate tolerance from sensitization and inform early risk stratification, but longitudinal studies beginning in pregnancy and extending through early childhood will be needed to determine whether these IgG patterns are predictive markers or downstream consequences of allergic disease.

“I think that IgG reactant profiling could eventually inform early risk stratification or prevention strategies if the patterns that we're seeing or specific patterns in general are consistently replicated, and if they always come before allergy development across multiple different cohorts,” Angkeow said, “But we're not there yet, and there needs to be a lot of replication and mechanistic validation and protective studies before we can translate this into prevention strategies.”

Angkeow JW, Hong X, Thakar M, et al. Diverse food allergen IgG reactivities are associated with food allergies in the Boston Birth Cohort. Allergy. 2026. doi:10.1111/all.70246. 

https://pubmed.ncbi.nlm.nih.gov/41689198/

Angkeow J. Early-Life IgG Patterns Linked to Childhood Food Allergy, With Julia Angkeow. HCPLive. Published February 24, 2026. Accessed on March 24, 2026. 

https://www.hcplive.com/view/early-life-igg-patterns-linked-childhood-food-allergy-julia-angkeow

Angkeow discusses a recent study finding that PhIP-Seq analysis links diverse IgG responses to food allergy phenotypes.

Food Allergy

Learn how clinicians confirm iron deficiency anemia, interpret ferritin, and trace dietary, menstrual, or GI causes for targeted treatment.

Video Series

Diagnosing Iron Deficiency Anemia — Ferritin Thresholds, Confirmatory Testing, and Workup 

Abdallah Geara, MD, is an Associate Professor of Clinical Medicine at the University of Pennsylvania.

Articles

Geara breaks down the clinical framework for the modern era of IgA nephropathy. 


Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

Stratifying Risk, Optimizing Therapy in IgA Nephropathy, With Abdallah Geara, MD

Mark Taylor, MD, a consultant psychiatrist from The Edinburgh Practice and a professor in the school of medicine and dentistry at Griffith University.

National cohort study finds semaglutide tied to reduced depression, anxiety, and self-harm risk in patients with diabetes and comorbid mental illness.
 

Psychiatry

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Type 2 Diabetes

Semaglutide Linked to Lower Suicidality Risk in Diabetes, With Mark Taylor, MD

Discover how new IBD therapies, combo drugs, and microbiome research aim to predict response, prevent Crohn’s complications, and expand trial options.

Advancing Gastroenterology from the Frontlines of Patient Care 

Su discussed the role of delabeling non-narcotic analgesic allergy labels in obstetrics care.

Why De-Labeling NNAALs Should Be Routine Obstetrics Care, With Chang Su, MD

Mercedes Martinez, MD, is a professor of pediatrics and medicine, medical director of the intestinal transplant program at the Center for Liver Disease and Abdominal Organ Transplantation, and medical director of the pediatric abdominal organ transplantation program at NewYork-Presbyterian.

Martinez discusses unmet needs in pruritus management and maralixibat’s potential to expand treatment of itch across rare cholestatic liver diseases.

Hepatology

Expanding the Reach of Maralixibat in Rare Cholestatic Liver Diseases, With Mercedes Martinez, MD

Alex Hillenbrand is an assistant editor for 

. She earned her BA in English from Lafayette College in 2023 and went on to write for pop culture, entertainment, and sports media outlets before joining MJH Life Sciences in 2025. In her free time, Alex enjoys cooking, going on walks, and meeting new people. Contact her at mjhlifesciences.com.

ACG's 24 new HE recommendations tackle ammonia testing, lactulose titration, protein intake, and transplant criteria for cirrhosis patients.

ACG Issues New Hepatic Encephalopathy Guidelines For Diagnosis, Treatment, Nutrition, and Transplant, With Jasmohan Bajaj, MD, MS

Xiao Xiao, PhD, from the Behavioral and Cognitive Neuroscience Center at Fudan University.

Study reveals chronic pain reshapes hippocampus, driving depression risk. Microglia may be a therapeutic target, says Xiao.

Pain

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On the HCPLive chronic pain page, resources on the topics of medical news and expert insight into pain treatment can be found. Content includes articles, interviews, videos, podcasts, and breaking news on chronic pain, and more.

Chronic Pain, Depression Linked Through Hippocampal Remodeling, With Xiao Xiao, PhD

Accelerated rTMS shows comparable efficacy to standard care, with delayed response in some patients and no clear predictors of early benefit.

Accelerated 5×5 rTMS Matches Standard Protocols in TRD, With Andrew Leuchter, MD

Podcasts

In this episode of the Skin of Color Savvy podcast, 2 leaders in dermatology discuss the complexities of colorism and its impact on pigmentary disorders.

Skin of Color Savvy: The Art and Science of Treating Patients of Color

Hosted by Skin of Color Society and produced by HCPLive, 

 delves into the latest research, clinical insights, and culturally intelligent care practices in dermatology with leading experts. 

Whether it’s groundbreaking research, practice-changing insights, or highlights from the SOCS community, this twice-monthly program provides dermatologists and care providers with expert perspectives on treating patients with skin of color.

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podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, and Heart Trials.

Latest News

Updated ACC/AHA Dyslipidemia Guidelines Incorporate LDL-C Goals, Lp(a) Focus, With Deepak Bhatt, MD, MPH

The Case for Delabeling NNAALs in Obstetric Care, With Chang Su, MD

Why Exocrine Pancreatic Insufficiency Is Frequently Underdiagnosed, With Andres Gelrud, MD

Tegoprubart Improves Glycemic Control Following Islet Transplantation for T1D, With Piotr Witkowski, MD, PhD

IgG Reactivity Patterns in Pediatric Food Allergy, With Julia Angkeow