Lipid Management in Special Populations from 2026 Dyslipidemia Guidelines

The 2026 ACC/AHA Dyslipidemia Guideline expands its scope of individualized guidance for several high-risk populations, including patients with diabetes, HIV, chronic kidney disease (CKD), older adults, and cancer survivors, each now addressed with more specific risk-stratified recommendations and, in some cases, formal Class I designations.

For patients with diabetes, the guideline stratifies LDL targets based on the presence of diabetes-specific risk enhancers such as albuminuria or long disease duration. An LDL goal of less than 100 mg/dL applies broadly, with intensification to less than 70 mg/dL recommended when additional cardiovascular risk factors are present.

Writing committee member Ann Marie Navar, MD, PhD, notes ischemic cardiovascular disease has become the leading cause of death among persons living with HIV in the era of effective antiretroviral therapy. The guideline incorporates findings from the REPRIEVE trial, which demonstrated statin therapy significantly reduces cardiovascular events in this population, and now supports a formal recommendation for statin use as part of routine preventive care in persons living with HIV.

Patients with CKD and established ASCVD represent a particularly high-risk group; the guideline recommends an LDL goal of less than 55 mg/dL, driven by the elevated absolute event risk in this population and supportive subgroup data from major lipid-lowering trials. Cancer survivors with a life expectancy of two or more years are now explicitly included as a group requiring continued cardiovascular risk reduction.

For adults over age 75, Pamela B. Morris, MD, and Navar outline a nuanced approach: continuing established lipid-lowering therapy remains appropriate, while initiating statin therapy de novo should be individualized through shared decision-making, accounting for life expectancy, polypharmacy burden, and patient health priorities.

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.

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. J Am Coll Cardiol. Published online March 13, 2026. doi:10.1016/j.jacc.2025.11.016
2. 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