Viet Le, DMSc, PA-C, is a preventive cardiology PA at Intermountain Health and the former president of the Academy of Physician Associates in Cardiology.

Viet Le, DMSc, PA-C

ACC/AHA Dyslipidemia Guidelines Refocus Hypertriglyceridemia Treatment, With Viet Le, DMSc, PA-C

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.

Another core focus of the new guidelines is hypertriglyceridemia. In the updated document, patients with a triglyceride measurement of 150-999 mg/dL with 

atherosclerotic cardiovascular disease (ASCVD)

 and LDL-C or non-HDL-C above goal on max statins should receive intensified LDL-C lowering therapy first. Additionally, olezarsen, a new apoC3 inhibitor, has received the guidelines’ recommendation for patients with familial chylomicronemia syndrome with triglycerides ≥1000 mg/dL as an adjunct to diet.

“Hypertriglyceridemia gets a strong voice with the guidelines here, and it’s important to recognize that statins are still foundational,” Viet Le, DMSc, PA-C, associate professor of research and preventive cardiology PA at Intermountain Health and ACC editor in chief, told 

 in an exclusive interview. “When we talk about ASCVD risk, there’s still a dichotomy when we think about hypertriglyceridemia as either a risk for cardiovascular disease or as a pancreatitis risk.”

Le also breaks down the 5 most important takeaways from the guidelines, emphasizing the cornerstones of dyslipidemia management and care moving forward. These takeaways include the following:

Switch from the Pooled Cohort Equations to the AHA’s PREVENT calculator to predict ASCVD risk in patients with dyslipidemia

Monitor LDL-C and non-HDL-C targets, with >100 and >55, respectively, as key goals to shoot for in managing dyslipidemia

Monitor lipoprotein(a) in all patients, as it is a universal cascade predictor of ASCVD in patients with dyslipidemia and their relatives

Continue to monitor coronary artery calcium (CAC), a major predictor of ASCVD risk

Use the CPR model – Calculate 10-year ASCVD risk, Personalize the estimated risk by considering factors not included in the PREVENT equations, and Reclassify with selective use of CAC

Additionally, Le also addresses dietary supplements, a substantial player in modern lipid management despite not possessing clinical evidence of their efficacy. Supplements are widely used for their ostensible lipid-lowering effects, and Le recommends accepting this while encouraging patients to rely on medically proven therapies first and foremost.

“Folks should know that dietary supplements are not recommended for lipid lowering,” Le said. “Please recognize that we need to go to those things that have clinical evidence. Don’t frown on patients who want to use dietary supplements, but it has to be made clear that in the guidelines, we don’t have evidence that dietary supplements help in lowering LDL-C.”

Editors’ Note: Le reports disclosures with Janssen, Pfizer, Novartis, Idorsia, Amarin, and Lexicon.

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. 

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25). 

Videos

Le discusses the AHA/ACC clinical guidelines for the management of dyslipidemia, highlighting the shifting attitude towards hypertriglyceridemia treatment.

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

Among the most major changes in these guidelines is the shift from percent reduction of LDL-C back to specific, targeted goals. The 2018 version encouraged the use of percent LDL-C reductions as a method of monitoring lipid levels and guiding lipid-lowering therapy (LLT) across the board. Additionally, secondary prevention now includes LDL-C goals as well, with recommendations shifting for LDL-C ≥190 mg/dL and familial hypercholesterolemia (FH).

“I love coming back to goals,” Viet Le, DMSc, PA-C, associate professor of research and preventive cardiology PA at Intermountain Health and ACC editor in chief, told 

 in an exclusive interview. “It was a little nebulous to just throw out percent reduction of LDL cholesterol, so I think it’s helpful for patients and for clinicians alike to be able to see goals of where we’re going.”

Percent LDL-C reductions were widely considered vague, given their subjectivity between patients. Now, although the guidelines retain percentage reduction in LDL-C as a priority for individuals, with goals for percent reduction dependent on the level of 

atherosclerotic cardiovascular disease (ASCVD

) risk, LDL-C and non-HDL-C treatment goals are once again forming the backbone of LLT guidance.

Specific goals are largely determined by PREVENT risk tier. Those at borderline risk – between 3 and <5% - have a goal LDL-C of <100 mg/dL and a goal non-HDL-C of <130 mg/dL. Patients at intermediate risk, or from 5 to <10%, have a goal LDL-C of <100 mg/dL. Those at high risk - ≥10% - have a goal LDL-C of <70 mg/dL and non-HDL-C of <100 mg/dL and should be given ezetimibe if the goal is not met on a maximum statin.

Secondary prevention markers will also incorporate LDL-C goals – patients at very high risk, or with ≥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 and should have ezetimibe added to max statin. Patients not at very high risk, however, have an LDL-C goal of <70 mg/dL and non-HDL-C of <100 mg/dL. Additionally, based on data from CLEAR OUTCOMES, bempedoic acid and inclisiran are now formally positioned as add-on options for very high-risk patients who cannot reach goal.

Finally, patients with severe hypercholesterolemia or FH have received recommendations as well. Patients with ASCVD have an LDL-C goal <55 mg/dL and should receive ezetimibe, while those without ASCVD but with heterozygous HF (HeFH) have a goal LDL-C <70 mg/dL with ezetimibe, PCSK9 inhibitors, and/or bempedoic acid added to max statin. Additionally, standard risk calculators like PREVENT and PCE explicitly not recommended for HeFH – the authors cite their tendency to underestimate risk. Instead, panel-based genetic testing should be used for FH.

“This is important,” Le said. “These are individuals with 1 event and 2 or more major risk factors, or 2 or more major events. They’re very high risk. And the guidelines make this clear. Most of our patients end up in the very high risk category if they have any events. Typically, they have 2 or more risk factors with them. So, less than 55 mg/dL should really be the clarion call and the goal that we think about for most of these individuals.”

Le discusses the AHA/ACC clinical guidelines for the management of dyslipidemia, highlighting the return of LDL-C target goals for ASCVD prevention.

ACC/AHA Dyslipidemia Guidelines Focus on PREVENT, Lp(a), With Viet Le, DMSc, PA-C

In addition to overhauling the process of evaluating and monitoring patients with dyslipidemia, this new document encourages a paradigm shift away from the Pooled Cohort Equations (PCE) to the AHA’s more modern and comprehensive PREVENT model. Additionally, the guidelines now cite lipoprotein(a) as a major marker of elevated LDL-C, and one that can be used as a cascade predictor across families.

“It’s a big change, going from the Pooled Cohort Equations to PREVENT,” Viet Le, DMSc, PA-C, associate professor of research and preventive cardiology PA at Intermountain Health and ACC editor in chief, told 

 in an exclusive interview. “You have to calculate the risk now using PREVENT, but you’re personalized with risk enhancers. Those are still there, and then ultimately you can reclassify with coronary calcium.”

Since 2018, the PCEs have been the cornerstone of lifetime risk prediction of severe hypercholesterolemia, starting at age 21. The earlier guidelines recommended their use in informing focused risk discussion, highlighting tobacco use, sedentary lifestyle, and poor diet. The inclusion of the PCEs marked a significant emphasis on clinician-patient risk discussion and shared decision making.

The updated guidelines encourage clinicians to instead make use of the AHA’s Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations for 10- and 30-year risk assessments to guide lipid-lowering therapy (LLT) in patients between ages 30 and 79. Unlike their predecessor, PREVENT included a lower limit to begin risk prediction as well as including a larger sample of US adults for validation. PREVENT ultimately produces far more accurate risk estimates compared to the PCEs, particularly for 

Another new component of the guidelines is the enhanced focus on lipoprotein(a), or Lp(a). The 2026 updated version recommends that clinicians measure Lp(a) ≥1 time in all adults when assessing for ASCVD risk, establishing a new Class of Recommendation (COR) 1 suggestion.

“Lp(a) helps us to do what’s called cascade screening. If you get it in everyone, a universal screening, then you can identify families where it’s elevated and implement therapies so much sooner. And not just pharmacologic therapy, but optimizing lifestyle,” Le said. “So, we need to test universally, at least once in everyone, identify those with high alkyl A, and then use that for cascade screening out to siblings, to children, and to children of siblings, all of whom may have elevated Lp(a).”

Le discusses the AHA/ACC clinical guidelines for the management of dyslipidemia, highlighting PREVENT and a renewed focus on Lp(a).

Smoothing the Road: Improving Heart Failure Awareness Among Clinicians and Patients

 is among the most devastating diseases in cardiology. Based on statistics from the Heart Failure Society of America (HFSA), HF contributed to 425,147 deaths in the US in 2022, accounting for 45% of all cardiovascular mortality. Roughly 6.7 million Americans >20 years have HF – this number is expected to reach 8.7 million by 2030, 10.3 million in 2040, and 11.4 million by 2050.

These statistics continue to rise in spite of a slew of available treatments and medications for HF and its associated risk factors. As more treatments are introduced and the overall prevalence of HF continues to increase, clinicians have largely turned to a lack of awareness of the options available to patients. Many drugs, including beta-blockers, mineralocorticoid receptor agonists, and SGLT2 inhibitors, have long since proven their efficacy in both clinical trials and real-world use; however, patient access to, and usage of, these drugs remain low.

In September of 2025, the Heart Failure Society of America and the American Society of Preventive Cardiology issued a joint statement on HF, aiming to reframe it as a preventable condition as opposed to an inevitable outcome. The document encouraged clinicians to prioritize the identification of risk factors, getting in front of the disease’s progression rather than treating it after it has manifested. It included strategies such as 

, lifestyle interventions, and genetic risk screening, among others.

Since the statement’s release, the HF conversation has largely shifted towards prevention. Multiple specialties, primarily nephrology and endocrinology, have been folded into the overall prevention cascade as more interdisciplinary treatments come to light. GLP-1 receptor agonists, such as semaglutide, have demonstrated substantial reductions in many risk factors for HF, while up-and-coming non-steroidal MRAs have provided promising results further upstream in the disease’s progression.

As we enter 2026, further research and progress can be enhanced by increasing awareness of the options available to patients. Addressing issues such as stepwise prescription and working through prior authorization can increase patient access to crucial medications. A more universal interpretation of HF as a preventable condition may bring more patients into the clinic as they learn the importance of locating risk factors early. And interdisciplinary work between heart failure clinicians and preventive cardiologists, as well as between specialties like nephrology and endocrinology, can enhance the care that we are already providing for patients.

Editor’s Note: Le reports disclosures with Janssen, Pfizer, Novartis, Idorsia, Amarin, and Lexicon. Gulati reports disclosures with Novartis, Esperion, Boehringer Ingelheim, and Merck. Vaduganathan reports disclosures with Amgen, AstraZeneca, Bayer AG, Cytokinetics, Lexicon, Boehringer Ingelheim, and others.

Fonarow GC, Ahmad FS, Ahmad T, et al. HF stats 2025: Heart Failure Epidemiology and Outcomes Statistics an updated 2025 report from the Heart Failure Society of America. Journal of Cardiac Failure. 2026;32(2):439-498. 

Heart Failure Society of America. Heart Failure Society of America and American Society for Preventive Cardiology Joint Statement Calls for a Shift in Heart Failure Prevention and Care. August 13, 2025. Accessed February 13, 2026. 

https://hfsa.org/heart-failure-society-america-and-american-society-preventive-cardiology-joint-statement-calls-0

This Heart Failure Awareness Week, revisit recent advancements and scope out the future of heart failure care with HCPLive.

Viet Le, DMSc, PA-C

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