ACC/AHA Dyslipidemia Guidelines Focus on PREVENT, Lp(a), 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 dyslipidemia, replacing the 2018 Guideline on the Management of Blood Cholesterol.1

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.1

“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 HCPLive 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.2

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 atherosclerotic cardiovascular disease (ASCVD).1

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.1

“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).”

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

References

1. 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. doi:10.1161/cir.0000000000001423

2. 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). doi:10.1161/cir.0000000000000625