Mega Doctor News
By UT Southwestern Medical Center
DALLAS – New national guidance for managing cholesterol and other blood lipids calls for earlier risk assessment, more personalized treatment, and renewed emphasis on long-term cardiovascular prevention – changes experts say could significantly reduce heart attacks and strokes over a lifetime.
As part of the updated recommendations, treatment to lower lipid levels may be considered starting at age 30 for adults at high long-term risk of heart disease or high levels of low-density lipoprotein cholesterol (LDL-C), reflecting growing evidence that intervention at a younger age can reduce long-term risk of heart attacks and strokes.
Faculty from UT Southwestern Medical Center played key roles in developing and reviewing the recommendations, which were released March 13 by the American College of Cardiology (ACC) and the American Heart Association (AHA) and endorsed by nine other major professional societies.
The 2026 ACC/AHA Guideline on the Management of Dyslipidemia, published simultaneously in the Journal of the American College of Cardiology and Circulation, replaces the 2018 cholesterol guideline. The updates reflect advances in cardiovascular risk prediction, lipid testing, and treatment options. A central theme is identifying and treating elevated cholesterol at a younger age to reduce cumulative exposure to plaque-causing, artery‑damaging lipids and lower the risk of atherosclerotic cardiovascular disease (ASCVD), the leading cause of death worldwide.
An estimated 1 in 4 adults in the U.S. has a high level of LDL-C, commonly known as “bad” cholesterol, which is linked to cardiovascular disease.
Three of UT Southwestern’s preventive cardiologists played key roles in the update process. Ann Marie Navar, M.D., Ph.D., Associate Professor of Internal Medicine and in the Peter O’Donnell Jr. School of Public Health, was a member of the Guideline Writing Committee. Parag Joshi, M.D., Associate Professor of Internal Medicine in the Division of Cardiology and Medical Director of the Cardiac Rehabilitation Program, was a member of the Peer Review Committee. Anand Rohatgi, M.D., Professor of Internal Medicine in the Division of Cardiology, served as co-Chair of the Peer Review Committee.
“Clinical trials have continued to show us that lower is better, and we now have multiple therapies beyond statin drugs to lower cholesterol and prevent heart attacks and strokes,” Dr. Navar said. “Our job now is to work to translate these guidelines to practice, to help our patients reach these evidence-based goals.”
Among the most notable changes, the guideline recommends using the newer AHA equations – Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) – to estimate 10‑year risk starting at age 30. In adults up to age 59, 30-year risk also can be estimated. This approach allows clinicians and patients to consider lifetime risk and supports conversations about lifestyle changes and medication when appropriate.
The guideline also lists treatment targets for LDL-C, with lower goals for those at increasingly higher risk. To prevent a first heart attack or stroke, the LDL-C goal should be less than 100 mg/dL for people without risk factors. For those at risk for heart disease including those with diabetes or an elevated 10-year risk, the LDL-C goal is below 70 mg/dL. For those who have already had a heart attack or stroke and are at highest risk of cardiovascular events, the LDL-C goal is below 55 mg/dL.
The new guidance also expands the role of testing. Coronary artery calcium (CAC) scoring is recommended for borderline or intermediate risk adults who are uncertain about whether to start cholesterol medicine. CAC testing uses a CT scan to identify evidence of cholesterol buildup in the arteries. If any CAC is present, statins are recommended. The guideline also recommends all adults have a lipoprotein(a) [Lp(a)] test at least once in their lifetime. Lp(a) is a type of cholesterol that increases the risk of heart disease but is not detected by traditional cholesterol tests.
Although Lp(a)-lowering therapies are still investigational, the guidelines recommend patients with a high Lp(a) undergo more intensive cholesterol-lowering. Because Lp(a) is mostly determined by genetics and very stable over a lifetime, the test does not need to be repeated. The guideline also provides treatment goals for ApoB, a different way to measure “bad” cholesterol particles that may be more accurate than LDL-C.
“Cardiovascular disease remains highly preventable, yet too many people experience heart attacks or strokes before risk is recognized,” Dr. Joshi said. “These recommendations give clinicians better tools to personalize care and identify patients who may benefit from intervention, particularly younger adults and those with family histories of heart disease.”
Lifestyle modification remains the foundation of cardiovascular disease prevention, including a healthy diet, regular physical activity, weight management, blood pressure control, and tobacco avoidance. For many, lifestyle changes are not enough to reach cholesterol goals, and medications are needed. Statins remain the cornerstone of therapy, with additional medications recommended for certain patients to achieve optimal lipid control. After statins, the guidelines recommend using one of several evidence-based therapies that lower cholesterol to prevent cardiovascular events, including ezetimibe, bempedoic acid, and PCSK9 inhibitors.
“This guidance reflects a fundamental shift in how we think about cholesterol – not just as a short‑term number, but as a lifelong exposure that shapes cardiovascular risk,” Dr. Rohatgi said. “By intervening sooner and using better risk assessment tools, we have a real opportunity to prevent disease rather than simply treating it after the fact.”
UT Southwestern has been a leader in cholesterol research for decades. In 1985, Michael Brown, M.D., and Joseph Goldstein, M.D., were awarded the Nobel Prize in Physiology or Medicine for their discovery of the LDL receptor and its role in cholesterol regulation. Their findings led to the development of statins, which revolutionized cardiac preventive care. And findings from the Dallas Heart Study, a longitudinal study launched by UTSW in 2000, led to the development of a new class of drugs that lowers LDL levels by inhibiting the PCSK9 gene.
UT Southwestern is ranked among the top 20 programs in the nation for Cardiology, Heart & Vascular Surgery by U.S. News & World Report and has earned The Joint Commission’s Gold Seal of Approval® as a Comprehensive Cardiac Center.
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