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 dyslipidemia, replacing the 2018 Guideline on the Management of Blood Cholesterol.1

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.1,2

“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 HCPLive 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.

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