Ann Marie Navar, MD, PhD, is an associate professor of cardiology at the University of Texas Southwestern Medical Center.

Ann Marie Navar, MD, PhD

Part 1 of a 9-part series on the 2026 dyslipidemia guidelines created in collaboration with the ACC. 

Behind the Guidelines: Top Clinical Takeaways From the 2026 Dyslipidemia Guidelines

The 2026 ACC/AHA Dyslipidemia Guideline represents a transformative advance in cardiovascular risk management, which the organizations hope clinicians can navigate effectively by anchoring to a focused set of key principles cutting across the guideline's extensive breadth.

Pamela B. Morris, MD, vice chair of the writing committee, and Ann Marie Navar, MD, PhD, close the HCPLive Special Report series with a synthesis of the most clinically actionable updates. At the core of the guideline is a transition from the Pooled Cohort Equations to the AHA PREVENT equations, providing more accurate absolute risk estimates and enabling risk assessment beginning at age 30. When treatment decisions remain uncertain in borderline-to-intermediate risk patients, the Calculate-Personalize-Reclassify model using coronary artery calcium (CAC) scoring offers a structured framework for individualized decision-making. Any nonzero CAC score signals subclinical atherosclerosis and triggers risk-stratified treatment goals; a score above 300 approaches the risk profile of secondary prevention, and a score above 1,000 warrants very high-risk management.

Universal Lp(a) measurement, at least once in all adults, is now a Class I recommendation, alongside the first-ever US guideline inclusion of apolipoprotein B for selected populations. 

Absolute LDL cholesterol goals have been restored: 

Less than 55 mg/dL for very high-risk patients

Less than 70 mg/dL for high-risk individuals

Less than 100 mg/dL for primary prevention

With the principle lower is always better applied across all risk categories.

The therapeutic armamentarium has expanded substantially since 2018. Beyond statins and ezetimibe, clinicians now have access to bempedoic acid, PCSK9 monoclonal antibodies, inclisiran, and, for select populations, evinacumab and APOC3 inhibitors. As Navar summarizes, patients and clinicians alike can orient around three numbers, 55, 70, and 100, as guiding targets for the highest-risk, intermediate, and lower-risk groups, respectively. The tools to achieve LDL goals for even the most complex patients now exist; the priority must shift to ensuring those tools are applied.

Morris has no relevant disclosures to report. Navar reports disclosures with Amge, Arrowhead Pharmaceuticals, AstraZeneca, Bayer, Eli Lilly and Company, Esperion, Johnson & Johnson, Merck, Miga Health, NewAmsterdam Pharma, Novartis, Novo Nordisk, Sanofi, and Silence Therapeutics, among 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. 

. Published online March 13, 2026. doi:10.1016/j.jacc.2025.11.016

American College of Cardiology. ACC/AHA Issue Updated Guideline for Managing Lipids, Cholesterol - American College of Cardiology. American College of Cardiology. Published March 13, 2026. Accessed March 23, 2026. https://www.acc.org/About-ACC/Press-Releases/2026/03/13/18/01/ACCAHA-Issue-Updated-Guideline-for-Managing-Lipids-Cholesterol

Videos

New dyslipidemia guidance sharpens risk with CAC, checks lipoprotein(a), and targets LDL goals using expanded therapies for prevention.

Part 8 of a 9-part series on the 2026 dyslipidemia guidelines created in collaboration with the ACC. 

Understanding New Recommendations on FH and High Trigs in 2026 Dyslipidemia Guidelines

The 2026 ACC/AHA Dyslipidemia Guideline provides its most granular guidance yet for patients with familial hypercholesterolemia (FH) and severe hypertriglyceridemia, with new genetic testing recommendations, a novel therapy for homozygous FH, and the first extensive management framework for triglyceride-related risk across the full severity spectrum.

Writing committee members Pamela B. Morris, MD, and Ann Marie Navar, MD, PhD, walk through four distinct patient groups defined by LDL elevation and FH status. For patients with LDL cholesterol above 190 mg/dL without meeting clinical or genetic FH criteria, the LDL goal is less than 100 mg/dL, with combination therapy recommended when statins alone are insufficient. 

Heterozygous FH carries a more aggressive target of less than 70 mg/dL, reflecting the cumulative cardiovascular risk conferred by years of elevated LDL exposure. In patients with heterozygous FH and established ASCVD, the goal tightens further to less than 55 mg/dL. For homozygous FH, a rare but severe condition in which minimal to absent LDL receptor function renders most conventional therapies substantially less effective, the guideline introduces evinacumab, an ANGPTL3 inhibitor lowering LDL through a mechanism entirely independent of LDL receptor upregulation. 

Both evinacumab and lomitapide receive Class IIb recommendations in this population. Genetic testing for FH is now formally recommended, as monogenic variants can be identified in patients with LDL levels below the 190 mg/dL threshold, and genetic confirmation facilitates cascade screening among at-risk family members.

In hypertriglyceridemia, the guideline, reflecting its renamed scope as a dyslipidemia rather than blood cholesterol document, establishes ASCVD risk, not pancreatitis, is the primary concern for most patients with triglycerides below 500 mg/dL, reinforcing statin therapy as foundational in this group. Above 500–1000 mg/dL, fibrates and high-dose prescription omega-3 fatty acids are appropriate adjuncts. 

For patients with familial chylomicronemia syndrome (FCS), a rare condition marked by severe triglyceride elevation and recurrent pancreatitis resistant to standard lipid-lowering therapy, olezarsen, an APOC3 inhibitor, is now recommended. Plozasiran, approved after the guideline's evidence review concluded, represents an additional emerging option. Morris and Navar also recommend referral to a registered dietitian for patients at risk of pancreatitis, given the complexity of dietary management in severe hypertriglyceridemia.

New dyslipidemia guidance sets LDL targets for FH, urges genetic testing, and highlights evinacumab and APOC3 drugs for severe triglycerides.

Expert Insights: Recommendations on FH, Triglycerides in 2026 Dyslipidemia Guidelines

Part 7 of a 9-part series on the 2026 dyslipidemia guidelines created in collaboration with the ACC. 

Understanding Secondary Prevention Goals, Novel Lipid Therapies from 2026 Dyslipidemia Guidelines

Secondary prevention in the 2026 ACC/AHA Dyslipidemia Guideline is defined by an intensified focus on achieving LDL cholesterol goals rapidly and systematically, with a tiered framework distinguishing very high-risk patients from the broader ASCVD population and introducing updated guidance on sequencing of both established and newer lipid-lowering agents.

Ann Marie Navar, MD, PhD, a writing committee member and cardiovascular prevention specialist, outlines the characteristics defining very high-risk status: two or more prior cardiovascular events, or a single prior event accompanied by two or more high-risk features such as age over 65, active smoking, diabetes, heart failure, hypertension, or LDL above 100 mg/dL despite statin and ezetimibe therapy. For these individuals, the LDL cholesterol goal is less than 55 mg/dL. 

The guideline acknowledges this threshold represents an area of ongoing evidence generation. Data from the VESALIUS trial, which examined PCSK9 inhibition in a lower-risk ASCVD population, were unavailable during the evidence review period closing in April 2025. For patients with ASCVD not meeting very high-risk criteria, an LDL target of less than 70 mg/dL is recommended, though the guideline offers an optional recommendation of less than 55 mg/dL for clinicians preferring a uniform target across the ASCVD population.

When statins alone are insufficient to achieve goal, the guideline provides Class I recommendations for the addition of ezetimibe and/or bempedoic acid and/or a PCSK9 monoclonal antibody. Bempedoic acid, newly approved since the 2018 guideline, now carries cardiovascular outcomes support from clinical trial data in statin-intolerant patients across both primary and secondary prevention settings. Inclisiran, a small interfering RNA targeting PCSK9, receives a Class IIa recommendation for patients unable to access or tolerate PCSK9 monoclonal antibodies, with cardiovascular outcomes data still pending.

Navar and committee vice chair Pamela B. Morris, MD, note ezetimibe and statins remain the most accessible starting point given their generic availability and tolerability profile. Selection among newer agents depends on patient preference, comorbidities, bempedoic acid is contraindicated in patients with gout, and the realities of insurance coverage and drug access, which vary substantially across practice settings.

Part 6 of a 9-part series on the 2026 dyslipidemia guidelines created in collaboration with the ACC. 

Expert Insights: Why Dietary Supplements Do Not Lower Cholesterol

For the first time, the 2026 ACC/AHA Dyslipidemia Guideline includes a formal recommendation against the use of dietary supplements for lipid lowering, a position supported by randomized controlled trial evidence and one carrying significant implications for patient counseling and shared decision-making in cardiovascular prevention.

Pamela B. Morris, MD, vice chair of the writing committee, and Ann Marie Navar, MD, PhD, address this topic with candor, acknowledging the appeal of supplement-based approaches while emphasizing wishful thinking cannot override clinical evidence. 

Randomized trial data demonstrate the most commonly promoted dietary supplements, including omega-3 fatty acids in supplement formulations, vitamin D, vitamin E, vitamin C, and red yeast rice extract, fail to produce meaningful LDL cholesterol reduction or cardiovascular event reduction. The SPORT trial, comparing very low-dose rosuvastatin (5 mg) against multiple supplements including red yeast rice, found minimal to no benefit from the supplement arm in terms of LDL lowering.

Navar draws particular attention to the regulatory distinction between supplements and pharmaceuticals: the "supports heart health" labeling permitted on supplements carries no requirement for demonstrated disease prevention benefit. Red yeast rice extract, she explains, contains lovastatin as its active ingredient, but unlike a prescribed statin, it arrives without standardized dosing, pharmaceutical-grade manufacturing controls, or regulatory oversight. For patients seeking to lower LDL or reduce cardiovascular event risk, the guideline directs clinicians toward evidence-based pharmacotherapy.

This recommendation is expected to generate pushback from some patients, particularly those preferring "natural" approaches or harboring concerns about statin side effects. It reinforces the guideline's broader message: clinicians should ground these conversations in outcomes data, and the expanded pharmacologic toolkit now available, including non-statin options with robust cardiovascular outcomes evidence, leaves little clinical justification for relying on unproven supplement regimens.

Trials show most heart supplements don’t lower LDL or prevent events; learn why omega‑3s, vitamins and red yeast rice fall short of statins.

Ann Marie Navar, MD, PhD

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