By Paul Oh, MD, MSc, FRCPC, FACP, FAACVPR

AACVPR recently hosted a webinar updating cardiopulmonary professionals on contemporary issues related to lipid care. This was a timely and relevant session that provided suggestions on clinical care and described a few highlights of the 2026 American Heart Association (AHA)/American College of Cardiology (ACC)/AACVPR dyslipidemia guidelines that were published in March 2026. Here are five highlights of the guidelines and the webinar:

A central update is the adoption of the PREVENT risk calculator, which replaces older pooled cohort equations. PREVENT integrates cardiovascular, kidney, and metabolic variables and estimates both 10‑year and 30‑year risk of total cardiovascular disease, including atherosclerotic cardiovascular disease (ASCVD) and heart failure. This broader and more contemporary approach improves risk prediction and supports earlier, individualized prevention strategies. 

The guidelines redefine risk categories based on 10‑year PREVENT estimates: low (<3%), borderline (3–<5%), intermediate (5–<10%), and high (≥10%). These categories now drive therapeutic decisions more directly, with pharmacologic therapy considered even at relatively low (borderline) risk levels, reflecting a shift toward earlier intervention.

Targets are back! Another major change is the return of more stringent LDL cholesterol (LDL-C) targets. Specific numeric goals are emphasized, including <100 mg/dL for lower‑risk patients, <70 mg/dL for high‑risk individuals, and <55 mg/dL for very high‑risk or secondary prevention populations. This represents a move back to goal-directed therapy, with an emphasis on “lower for longer” to reduce lifetime atherosclerotic exposure. 

The guidelines highlight expanding therapeutic options for LDL lowering. While statins remain first-line therapy, non‑statin agents increasingly are used earlier and more aggressively in order to achieve the lower LDL-C targets. These include ezetimibe and bempedoic acid, as well as potent PCSK9-targeted therapies such as monoclonal antibodies (alirocumab, evolocumab) and small interfering RNA agents like inclisiran, which can reduce LDL‑C by up to 50%–60%. The guideline also recognizes multiple new lipid-modifying agents in trials, underscoring a rapidly evolving treatment landscape. 

There are a number of opportunities in the rehab setting to improve lipid management, including a systematic screening program to identify people with LDL-C above target, addressing poor adherence to medication, or delivering education programs.

Overall, the new AHA/ACC/AACVPR guidelines emphasize earlier risk identification, stricter lipid targets, and broader use of advanced therapies to reduce cardiovascular risk over the lifespan.

Dr. Paul Oh is medical director of the Cardiovascular Disease Prevention and Rehabilitation Program at University Health Network in Toronto, Canada.

REFERENCE:

Blumenthal et al. Circulation. 2026;153:e00–e00. DOI: 10.1161/CIR.0000000000001423.