Key result
Updated 2026 dyslipidemia framework reclassifies ~10M US adults while maintaining similar lipid-lowering therapy eligibility.
Why the study?
The 2026 ACC/AHA dyslipidemia guideline replaces the pooled cohort equations with the Predicting Risk of Cardiovascular Disease Events equations and modifies primary prevention lipid-lowering therapy eligibility criteria, but the population-level impact of this transition was uncertain.
Does the 2026 PREVENT-based ACC/AHA dyslipidemia framework change lipid-lowering therapy eligibility compared to the 2018 pooled cohort equations-based framework in US adults aged 40 to 75 years without ASCVD?
Cross-Sectional (n=1,662)
Does the 2026 PREVENT-based ACC/AHA dyslipidemia framework change lipid-lowering therapy eligibility compared to the 2018 pooled cohort equations-based framework in US adults aged 40 to 75 years without ASCVD?
Transitioning to the 2026 PREVENT-based dyslipidemia guideline results in minimal net change in total US adults eligible for lipid-lowering therapy (-0.65 million), but substantially reclassifies individual eligibility (10.15 million total reclassified) while highlighting persistent undertreatment (~40% current use).
Answers are grounded in this paper and cite their sources.
Undertreatment gaps persist across guidelines; leaves open whether PREVENT equations improve risk targeting in observational data.
BACKGROUND: The 2026 American College of Cardiology/American Heart Association dyslipidemia guideline replaces the pooled cohort equations with the atherosclerotic cardiovascular disease component of the Predicting Risk of Cardiovascular Disease Events equations for primary prevention risk estimation and modifies lipid-lowering therapy (LLT) eligibility by lowering the risk-based treatment threshold and expanding diabetes and chronic kidney disease criteria. The population-level impact of this transition is uncertain. METHODS: We analyzed National Health and Nutrition Examination Survey 2021 to 2023 participants aged 40 to 75 years without self-reported atherosclerotic cardiovascular disease and with available low-density lipoprotein cholesterol. Survey weights were used to generate national estimates. Guideline-supported LLT eligibility was assessed under the 2018 pooled cohort equations-based American College of Cardiology/American Heart Association cholesterol framework and the 2026 Predicting Risk of Cardiovascular Disease Events-based American College of Cardiology/American Heart Association dyslipidemia framework. Current LLT use was assessed among guideline-supported adults. RESULTS: The analytic sample included 1662 participants, representing 115.05 million US adults. LLT was supported for 42.82 million adults under the 2018 framework and 42.17 million under the 2026 framework, a net decrease of 0.65 million. Reclassification was substantial: 37.42 million remained supported, 5.40 million lost support, 4.75 million newly gained support, and 67.48 million remained unsupported. Among supported adults, current LLT use was 39.4% under the 2018 framework and 40.5% under the 2026 framework. CONCLUSIONS: Transition to the 2026 Predicting Risk of Cardiovascular Disease Events-based framework produced little net change in LLT eligibility but meaningfully changed who was supported for therapy. Persistent undertreatment remains a major implementation gap.
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Hyun et al. (2026) conducted a cross-sectional in Primary prevention of atherosclerotic cardiovascular disease / Dyslipidemia (n=1,662). 2026 ACC/AHA PREVENT-based dyslipidemia guideline framework vs. 2018 ACC/AHA pooled cohort equations-based cholesterol framework was evaluated on Guideline-supported lipid-lowering therapy (LLT) eligibility and current LLT use among supported adults. The 2026 ACC/AHA dyslipidemia framework supported lipid-lowering therapy in 42.17M vs 42.82M US adults under the 2018 guideline, reclassifying 10.15M adults.
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