2026 Dyslipidemia Guidelines: Key Updates for Pharmacy Practice

In an interview with Pharmacy Times, Joseph Saseen, PharmD, BCPS, BCACP, CLS, professor and associate dean for clinical affairs in the Department of Clinical Pharmacy at the University of Colorado Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences, discussed the 2026 American College of Cardiology/American Heart Association dyslipidemia guidelines—the first update since 2018—explaining the key changes pharmacists need to understand and apply in clinical practice.

Saseen noted that 8 years of accumulated evidence in lipid management and preventive cardiovascular care made an update necessary and that the 2026 guidelines reflect meaningful advances in how clinicians should approach risk stratification and treatment goals.

A central update is the replacement of the Pooled Cohort Equations with the PREVENT–Atherosclerotic Cardiovascular Disease (ASCVD) calculator for primary prevention patients. Saseen emphasized that clinicians should not assume the same risk thresholds apply; the PREVENT calculator produces lower benchmarks because it is a more accurate tool. Unlike its predecessor, PREVENT incorporates additional patient-specific variables, including measures of glycemia, body mass index, and kidney function, and offers optional inputs for even greater precision. It accommodates patients aged 30 to 79 years and generates both a 10-year ASCVD risk estimate—used to guide treatment recommendations—and a 30-year risk projection. Saseen noted that for dyslipidemia purposes, clinicians should focus specifically on the ASCVD output rather than the cardiovascular disease or total cardiovascular disease outputs, which are more relevant to hypertension management.

“Clinicians don’t think in thresholds. Clinicians need goals to get to discrete end points that extrapolate to clinical benefits, and we have them now in this new guideline.” – Joseph Saseen, PharmD, BCPS, BCACP, CLS

The second major update is the shift from treatment thresholds to discrete low-density lipoprotein cholesterol (LDL-C) goals, a change Saseen described as long overdue. Rather than the previous threshold-based language that prompted clinicians to consider intensifying therapy, the 2026 guidelines provide clear, population-specific LDL-C targets that directly map to clinical benefit. The primary goal remains LDL-C, with non–high-density LDL-C as an important corollary. For select patients, particularly those with established ASCVD or metabolic conditions such as diabetes, metabolic syndrome, or hypertriglyceridemia, an optional apolipoprotein B goal can further confirm that atherogenic lipoproteins are adequately controlled once LDL and non-HDL targets are met.