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Are your patients at their LDL-C goal?

2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA
Guideline on the Management of Dyslipidemia

Updated Multi-Society Guidelines Emphasize Assessment
and Management of LDL‑C1

At Risk of ASCVD (Primary Prevention)

LDL-C Goal <100 mg/dLa

Patient Population (Patients meeting any of the following criteria)

  • Risk calculation with PREVENT-ASCVD <10% for ages 30–79 yearsb,c
  • Severe hypercholesterolemia without FH, ASCVD risk factors, and subclinical atherosclerosis
  • Subclinical atherosclerosis in men ≥40 or women ≥45 years of age with CAC 1–99 AU and <75th percentile for age, sex, and raced
  • Diabetes, age 40–75 years without ASCVD risk factors or diabetes-specific risk modifiersd,e
  • Hypertriglyceridemia, <50 years old with no additional risk enhancers

LDL-C Goal <70 mg/dLf

Patient Population (Patients meeting any of the following criteria)

  • Risk calculation with PREVENT-ASCVD ≥10% for ages 30–79 yearsg,h
  • Severe hypercholesterolemia with FH, ASCVD risk factors, and subclinical atherosclerosis
  • Subclinical atherosclerosis in men ≥40 or women ≥45 years of age with
    • CAC ≥100–299 AU and ≥75th percentile for age, sex, and raceh
    • CAC ≥300–999 AUh,i
  • Diabetes, age 40–75 years with ASCVD risk factors or diabetes-specific risk modifiersh,j
  • Hypertriglyceridemia, age 40–75 years with ≥1 ASCVD risk factorj

LDL-C Goal <55 mg/dLk,l

Patient Population (Patients meeting any of the following criteria)

  • Subclinical coronary atherosclerosis in men ≥40 or women ≥45 years of age with CAC ≥1,000 AUh

With Clinical ASCVD (Secondary Prevention)

LDL-C Goal <70 mg/dLf

Patient Population (Patients meeting any of the following criteria)

  • Not at very high riskh,i
  • Hypertriglyceridemia with clinical ASCVD not at very high riskj

LDL-C Goal <55 mg/dLk

Patient Population (Patients meeting any of the following criteria)

  • At very high riskh,m,n
  • Severe hypercholesterolemia or HeFH with clinical ASCVD
  • Hypertriglyceridemia with clinical ASCVD at very high riskm,n
  • With CKDh

Additional Atherogenic Lipoprotein Goals:

  • aNon–HDL-C <130 mg/dL
  • bIf TG ≥150–499 mg/dL, apoB goal: <90 mg/dL
  • cIn addition to the specified LDL-C goal, ≥30% LDL-C reduction is also recommended
  • dIn addition to the specified LDL-C goal, ≥30–49% LDL-C reduction is also recommended
  • eapoB goal: <90 mg/dL
  • fNon–HDL-C <100 mg/dL
  • gIf TG ≥150–499 mg/dL, apoB goal: <70 mg/dL
  • hIn addition to the specified LDL-C goal, ≥50% LDL-C reduction is also recommended
  • iOptional goal: LDL-C <55 mg/dL, non–HDL-C <85 mg/dL,and consider apoB goal <55 mg/dL
  • japoB goal: <70 mg/dL
  • kNon–HDL-C <85 mg/dL
  • mapoB goal: <55 mg/dL

lCategory added in 2026 Guidelines. nDefined as ≥2 major ASCVD events, or 1 major ASCVD event and ≥2 high-risk conditions. ASCVD events include ACS within the past 12 months, history of myocardial infarction other than ACS, history of ischemic stroke, or symptomatic PAD. High-risk conditions include age ≥65 years, coronary bypass or percutaneous intervention, current smoker, diabetes, history of congestive heart failure, hypertension, or LDL-C ≥100 mg/dL despite conventional management.

AACVPR = American Association of Cardiovascular and Pulmonary Rehabilitation; ABC = Association of Black Cardiologists; ACC = American College of Cardiology; ACPM = American College of Preventive Medicine; ACS = acute coronary syndrome; ADA = American Diabetes Association; AGS = American Geriatrics Society; AHA = American Heart Association; APhA = American Pharmacists Association; apoB = apolipoprotein B; ASCVD = atherosclerotic cardiovascular disease; ASPC = American Society for Preventive Cardiology; AU = Agatston units;
CAC = coronary artery calcium; CKD = chronic kidney disease; FH = familial hypercholesterolemia; HDL-C = high-density lipoprotein cholesterol; HeFH = heterozygous familial hypercholesterolemia; LDL-C = low-density lipoprotein cholesterol; NLA = National Lipid Association; PAD = peripheral artery disease; PCNA = Preventive Cardiovascular Nurses Association; PREVENT = Predicting Risk of cardiovascular disease EVENTs; TG = triglycerides.

In a 2019 extrapolation analysis, many adults with ASCVD did not achieve a LDL-C goal of <70 mg/dL or <55 mg/dL4,5o

oBased on an extrapolation analysis with descriptive statistics of 2019 data from the Truven MarketScan Research Database, extrapolating a population of 24,005,959 patients with ASCVD. Data from the Truven MarketScan Research Database is a large and representative database consisting of US administrative health records from commercial and Medicare supplemental health plans. Enrollees had 1 valid LDL-C measurement in 2019, were diagnosed with ASCVD, and were at least 21 years of age. Patients with likely heterozygous familial hypercholesterolemia were excluded. Patient numbers were extrapolated to approximate national figures using national demographic and ASCVD prevalence numbers.5

Learn more about the cumulative risk of ASCVD when LDL-C remains above goal2

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References: 1. Writing Committee Members; Blumenthal RS, Morris PB, 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. 2026;153:e1-e123.2. doi:10.1161/CIR.0000000000001423 2. Domanski MJ, Tian X, Wu CO, et al. Time Course of LDL Cholesterol Exposure and Cardiovascular Disease Event Risk. J Am Coll Cardiol. 2020;76(13):1507-1516. doi:10.1016/j.jacc.2020.07.059 3. Ference BA, Braunwald E, Catapano AL. The LDL Cumulative Exposure Hypothesis: Evidence and Practical Applications. Nat Rev Cardiol. 2024;21(10):701-716. doi:10.1038/s41569-024-01039-5 4. Writing Committee; Lloyd-Jones DM, Morris PB, et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022;80(14):1366-1418. doi:10.1016/j.jacc.2022.07.006 5. Gu J, Sanchez R, Chauhan A, et al. Lipid Treatment Status and Goal Attainment Among Patients With Atherosclerotic Cardiovascular Disease in the United States: A 2019 Update. Am J Prev Cardiol. 2022;10:100336. doi:10.1016/j.ajpc.2022.100336