A new national guideline is changing how doctors think about cholesterol—and the shift could affect when people are screened, how cardiovascular risk is measured and when treatment is considered.

In March 2026, the American College of Cardiology, American Heart Association and nine other medical organizations released updated guidance for managing dyslipidemia, a term that includes unhealthy levels of cholesterol, triglycerides and other blood lipids. The guideline replaces the 2018 cholesterol guideline and puts greater emphasis on identifying cardiovascular risk earlier, treating elevated cholesterol before years of exposure take a toll, and looking beyond LDL cholesterol alone.

The timing matters for communities that continue to experience significant disparities in cardiovascular health. Heart disease remains a leading cause of death in the United States, and CDC data show that Black adults have historically experienced the highest heart disease death rates among major racial and ethnic groups. In 2021, heart disease accounted for 22.6% of deaths among non-Hispanic Black people, compared with 18.0% among non-Hispanic White people and 11.9% among Hispanic people.

For patients, the new guidance represents a move away from waiting for cholesterol numbers—or a person’s age—to become alarming. Instead, clinicians are being encouraged to consider the full picture of cardiovascular risk earlier in life.

Earlier Risk Assessment, More Personalized Decisions

High cholesterol can be particularly difficult to identify because it usually causes no symptoms. A person can feel healthy while LDL cholesterol, sometimes called “bad” cholesterol, contributes to plaque buildup in the arteries over time. The CDC says the only way to know whether cholesterol is high is through testing. The 2026 guideline places greater emphasis on assessing risk earlier and across the lifespan. It introduces the AHA PREVENT equations to estimate both 10-year and 30-year cardiovascular risk, with risk assessment for many adults beginning at age 30 rather than waiting until later adulthood. Clinicians are also encouraged to consider factors that may not be fully captured by a risk calculator, including family history, certain reproductive health factors, chronic inflammatory conditions and biomarkers such as Lp(a).

The guideline also brings LDL-C and non-HDL-C treatment goals back into focus. For people at borderline or intermediate risk who need lipid-lowering therapy, the LDL-C goal is generally below 100 mg/dL. For people at high risk, the goal is below 70 mg/dL, while people with very high-risk cardiovascular disease may have an even lower target. That does not mean everyone with a particular cholesterol number automatically needs medication. Rather, the updated approach is intended to help clinicians and patients make decisions based on an individual’s overall risk.

One of the most significant additions is a stronger focus on lipoprotein(a), or Lp(a). Unlike the cholesterol numbers routinely included in a standard lipid panel, Lp(a) is not always tested. The new guideline recommends that every adult have their Lp(a) measured at least once. Lp(a) is largely determined by genetics and tends to remain relatively stable throughout life. Elevated levels can increase the risk of heart attack and stroke, and the American Heart Association notes that higher Lp(a) levels are more common among people of African descent. A level of at least 125 nmol/L is considered a risk-enhancing factor under the new guideline, while levels of 250 nmol/L or higher are associated with at least twice the estimated cardiovascular risk.

“Lower LDL is better, especially for people at increased risk for a heart attack or stroke,” said Pamela B. Morris, MD, FACC, FAHA, vice-chair of the 2026 guideline writing committee. She noted that clinical trials have demonstrated cardiovascular benefits from reducing LDL to levels lower than those recommended in previous guidelines.

The expanded use of coronary artery calcium, or CAC, testing is another important change. CAC scans use a CT scan to look for calcium in the arteries supplying the heart. Under the new guidance, CAC can help clarify cardiovascular risk when the decision about treatment is uncertain, particularly for men 40 and older and women 45 and older with borderline or intermediate risk.

For Black and Brown patients, however, expanding testing and risk assessment will only improve outcomes if people can actually access those services. Transportation, insurance coverage, medication costs, limited access to primary care and specialty care, and differences in health care quality can all influence whether cardiovascular risk is identified and treated. CDC research has repeatedly connected racial and ethnic health disparities with differences in access to prevention and treatment. That makes the guideline’s emphasis on earlier prevention particularly important. The goal is not simply to identify people who already have heart disease. It is to recognize risk sooner, understand the factors contributing to that risk and intervene before years of uncontrolled cholesterol and other cardiovascular risk factors result in a heart attack, stroke or other serious disease.

For patients, that conversation can start with a simple question: What are my numbers, and what do they mean for my long-term risk?

A cholesterol test can provide more information than a total cholesterol number alone. Depending on a person’s health history, a clinician may consider LDL-C, non-HDL-C, triglycerides, Lp(a) or, in selected cases, apolipoprotein B. Family history can also matter. Someone whose parent or sibling experienced cardiovascular disease at an unusually young age may have inherited risk that deserves additional attention. The new recommendations also recognize that cardiovascular prevention cannot be separated from broader health conditions. Diabetes, chronic kidney disease, high blood pressure and other conditions can substantially alter cardiovascular risk. The 2026 guideline recommends lipid-lowering therapy for certain adults ages 40 to 75 with diabetes, stage 3 or 4 chronic kidney disease, or HIV, regardless of LDL-C level or calculated PREVENT risk.

For communities already carrying a disproportionate burden of cardiovascular disease, the message is clear: cholesterol management is increasingly about prevention earlier, more complete risk assessment and individualized treatment—not simply waiting for a cholesterol number to become high enough to trigger concern. The new guideline does not eliminate the importance of healthy eating, physical activity, avoiding tobacco, maintaining a healthy weight, getting adequate sleep and managing conditions such as high blood pressure and diabetes. Those measures remain central to cardiovascular prevention. But lifestyle changes are not a substitute for understanding inherited risks such as elevated Lp(a), and people should not assume that feeling healthy means their cholesterol is healthy.

As clinicians begin putting the 2026 recommendations into practice, equitable implementation will be just as important as the recommendations themselves. Earlier testing and more precise risk assessment can only reduce disparities if patients have meaningful access to screening, follow-up care, affordable medications and trusted health information.

For Black and Brown communities, knowing a cholesterol number—and knowing what it means—can be an important first step. The new guidelines offer clinicians more tools to identify cardiovascular risk earlier. The next challenge is making sure those tools reach the people who stand to benefit from them most.

For patients looking for a practical place to start, “There’s Levels to This” campaign offers health education focused on understanding cholesterol, hyperlipidemia and cardiovascular risk. The campaign helps make complex information about cholesterol more accessible while encouraging people to learn their numbers, understand their risk factors and have informed conversations with their health care providers. That message aligns closely with the 2026 guideline’s emphasis on earlier risk assessment and more personalized prevention. For Black and Brown communities, resources that connect clinical recommendations with clear, culturally relevant health information can help turn awareness into action. Learn more through NMQF’s There’s Levels to This campaign.