2026 dyslipidemia guideline updates highlight earlier risk-based lipid management, expanded biomarker use, and a growing pharmacist role in cardiovascular prevention.
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; and Joel C. Marrs, PharmD, MPH, FAHA, FASHP, FCCP, FNLA, BCACP, BCCP, BCPS, CLS, cardiology ambulatory clinical pharmacist at Cheyenne Regional Medical Group Heart and Vascular Institute and associate professor at the University of Colorado School of Medicine, discussed key updates in the 2026 dyslipidemia guidelines and their implications for clinical and pharmacy practice.1
Saseen
Marrs
Pharmacy Times: Can you please introduce yourself?
Joseph Saseen, PharmD, BCPS, BCACP, CLS: Hello. My name is Joseph Saseen. I’m an associate dean for clinical affairs and a professor at the University of Colorado. I’m also a past president of the National Lipid Association and a member of the 2026 dyslipidemia guideline writing committee.
Joel C. Marrs, PharmD, MPH, FAHA, FASHP, FCCP, FNLA, BCACP, BCCP, BCPS, CLS: I’m currently a cardiology ambulatory clinical pharmacist with Cheyenne Regional Medical Group, Heart and Vascular Institute, and also an adjunct associate professor at the University of Colorado School of Medicine. Currently, in my practice, I see patients for both primary and secondary prevention of cardiovascular disease in our cardiology clinic.
Pharmacy Times: Why were new dyslipidemia guidelines necessary?
Saseen: Guidelines always need to be updated based on the most recent evidence, and our previous guideline was written in 2018, so a lot has happened over the past 8-year gap that needed to be incorporated. What you’ll see, if you read the 2026 dyslipidemia guideline, is that there are some significant updates and changes that reflect advances in the evidence we have with dyslipidemia, but also advances in preventive care and the way clinicians implement their risk-reduction strategies. I think those are better reflected in these 2026 guidelines.
Pharmacy Times: As a pharmacist author on these guidelines, what unique perspective did you bring to the writing committee?
Marrs: I think that’s an excellent question. One of the important things with the American College of Cardiology and the American Heart Association is that they do incorporate a lot of nonphysicians into the guidelines. So I was, fortunately, one of the pharmacists on the committee, and I feel like I was able to bring my perspective from practicing in integrated clinics for the past 20 years and be able to bring that to light in terms of how pharmacists can be utilized in those roles, especially with risk stratifying and screening.
I think my background in population health management was helpful during that process as well. And then, ultimately, having pharmacotherapy knowledge about the use of therapies, newer therapies, and being able to monitor for and discuss safety and medication-use optimization issues, I think, were the key pieces of my role on the committee.
Pharmacy Times: What are the most important changes for community pharmacists to implement immediately in their practice?
Marrs: I think one of the big themes that came out of the guidelines was being able to counsel patients on dyslipidemia management and trying to treat patients as early as possible to reduce their lifetime risk. I think highlighting that, especially for younger patients that pharmacists are interacting with, being able to evaluate their baseline risk, talking about the importance of getting their cholesterol tested, and then being able to talk with them about the new risk scoring tool incorporated in these guidelines—the PREVENT tool from the American Heart Association—are important.
That’s the new recommended tool over the old pooled cohort equation, and being able to educate patients that this is a better predictor of risk is important. We’re also recommending earlier management and adding therapy earlier, in addition to lifestyle, to help lower risk. Another area is measurement of lipoprotein(a). The guidelines recommend that every patient should have it checked at least once in their lifetime. That can provide additional risk information.
And lastly, the guidelines recommend more use of nonstatin therapy in addition to statin therapy, and pharmacists should be able to talk effectively with patients about where those fit into practice.
Pharmacy Times: The guidelines recommend expanded use of apolipoprotein B and lipoprotein(a) testing. When should pharmacists encourage providers to order these biomarkers?
Saseen: Apolipoprotein B [apoB] isn’t compulsory, but it is an option to confirm that a patient who has already achieved a goal—especially if they have ASCVD [atherosclerotic cardiovascular disease], kidney disease, or metabolic disease—has adequately treated atherogenic lipoproteins. Lipoprotein(a), or Lp(a), is different. We’ve known for decades that elevated Lp(a) correlates with a higher risk of developing ASCVD, other forms of cardiovascular disease, and even aortic valve disease.
In the past, it was optional to measure, and if elevated, it was considered a risk-enhancing factor. But these guidelines now recommend universal screening. Every adult should have Lp(a) measured, and younger individuals should be considered if they have a first-degree relative with elevated Lp(a). We don’t currently have FDA-approved therapies to treat elevated Lp(a), but it does influence clinical decision-making and how aggressively we manage lipid-lowering therapy and overall risk.
Marrs: We’ve had apoB testing around for many years, but this is the first time we’re calling it out in the guidelines with this update in 2026. We still have LDL-C [low-density lipoprotein cholesterol] goals and non–HDL-C goals as the primary focus, but there are some subpopulations where there can be discordance with the apoB level compared with the LDL level. Those populations include patients with diabetes, high triglycerides, or established cardiovascular disease if they’re not reaching their LDL-C goals.
Ultimately, the recommendation is to treat patients to their LDL goal, and if you want to further risk-stratify to identify residual risk, those are the patients where you might obtain an apoB to see if that’s elevated and then be more aggressive with therapy.
From a counseling standpoint, pharmacists should explain what the test is and that it’s another way to assess risk, but still emphasize LDL goals as the primary focus.
