New Cholesterol Guidelines 2026: What Changed

The 2026 ACC/AHA dyslipidemia guideline replaced the 2018 cholesterol guideline. It restored numeric LDL-C goals based on risk (under 100, 70, or 55 mg/dL), recommended universal once-in-a-lifetime lipoprotein(a) screening for all adults, switched to the PREVENT risk calculator, and formally recommended at least 5% weight loss for people who are overweight with high cholesterol.

Your LDL goal depends on your risk. For most healthy adults it is under 100 mg/dL. If you have risk factors or a prior heart event, the goal is under 70 mg/dL. For very-high-risk people with recent or multiple cardiovascular events, the goal is under 55 mg/dL. The 2026 guideline restored these specific numbers, which the 2018 version had dropped.

Lipoprotein(a), or Lp(a), is an inherited cholesterol particle that raises heart-disease and stroke risk independent of your LDL. Because it is largely genetic, a single test reveals your lifetime risk. About one in five people has an elevated level and most are unaware. The 2026 guideline recommends testing every adult once because it identifies hidden risk that standard cholesterol panels miss. See our Lp(a) test guide for what the number means and when to retest.

The 2018 guideline avoided firm LDL targets and focused mainly on LDL cholesterol. The 2026 guideline restores numeric LDL and non-HDL goals by risk, adds universal Lp(a) screening, uses the newer PREVENT risk calculator instead of the Pooled Cohort Equations, formally recommends weight loss, and expands its scope to cover high triglycerides and Lp(a).

Yes — the risk score behind the 2026 guideline is the American Heart Association's PREVENT calculator, free to use online with no sign-up. It takes your age, cholesterol numbers, blood pressure, BMI, and kidney function (plus optional A1c) and estimates your 10- and 30-year risk of heart disease, stroke, and heart failure, which is what determines which LDL goal tier applies to you. It's the same calculator your clinician's office should be using now that the 2026 guideline has replaced the older Pooled Cohort Equations.

Diabetes and established heart disease both push you toward the guideline's lower LDL tiers, but neither one automatically means the strictest <55 mg/dL target on its own — it depends on how much additional risk is layered on top, which is exactly what the PREVENT calculator is built to sort out. Diabetes alone, without other major risk factors, often still falls in the <70 mg/dL risk-factor tier; diabetes combined with additional risk factors (smoking, high blood pressure, kidney disease, a strong family history) can push the goal lower. Established coronary artery disease — a prior heart attack, stent, or bypass — generally places someone in the <70 mg/dL tier at minimum, and the strictest <55 mg/dL tier is reserved for very-high-risk patients with recurrent cardiovascular events or multiple major risk factors stacked together, not a single diagnosis by itself. Because the exact tier depends on your full risk profile rather than any one condition, run your numbers through the PREVENT calculator above and confirm your specific goal with your clinician rather than assuming a tier from a diagnosis alone.

No, Canada has not issued a 2026 update, and the Canadian Cardiovascular Society (CCS) 2021 dyslipidemia guideline remains current guidance. The CCS guideline states cholesterol thresholds in mmol/L rather than mg/dL and uses a modified Framingham Risk Score (FRS). It recommends statin therapy for an FRS of 20% or higher, or 10% to 19.9% when LDL-C reaches 3.5 mmol/L (roughly 135 mg/dL). If you were assessed under the Canadian guideline, your LDL goal and statin recommendation come from its FRS framework rather than PREVENT. Because the two systems use different risk models and are not interchangeable, ask your clinician which framework applies to your care.