Timothy Anderson said the 2026 cholesterol guidelines would expand statin eligibility to 21.5 million U.S. adults newly eligible for primary prevention therapy. The update shifts cholesterol-guideline decisions toward younger and lower-risk adults, using PREVENT risk estimates instead of the older pooled cohort equations.
Timothy Anderson and PREVENT
Anderson, of the University of Pittsburgh, said the change is a “sea change” for doctors counseling patients. He also said, “Before the new guidelines, people who were flagged with high cholesterol in their 30s and 40s tended to be recommended to focus on diet and exercise and were not recommended medication -- unless the patient already had heart disease or other factors that made them particularly high-risk, like diabetes.”
In the updated framework, lipid-lowering therapy can be considered at a 10-year PREVENT-ASCVD risk estimate of 3% to less than 5%, and it should be considered at 5% to less than 10%. The 2026 dyslipidemia guideline therefore moves treatment decisions earlier for some adults who would have remained below the older threshold.
NHANES cycles 2017-2023
Using NHANES cycles 2017-2023, Anderson and colleagues estimated that 87.5 million nonpregnant U.S. adults ages 30-79 years would be statin eligible under the 2026 guideline, including 21.5 million who were newly eligible. The newly eligible group had a mean estimated 10-year ASCVD risk of 3.1%, compared with 6.1% in the group previously recommended statins.
The same analysis described the newly eligible adults as largely younger and lower risk than those already recommended treatment. That leaves clinicians applying a broader prevention net to people who may not have crossed earlier treatment thresholds.
Allison Peng on recalibration
A separate analysis by Allison Peng and colleagues used data from 1999-2020 and adults ages 40-79 years. It found that 49.6% of individuals may be recommended lipid-lowering therapy under the 2026 guideline, compared with 49.4% before recalibration with PREVENT-ASCVD.
Peng wrote that there was “no significant net change in statin recommendation,” adding that PREVENT-ASCVD recalibration does not reduce the number of people recommended for evidence-based preventive therapy at the population level. In the same set of findings, two-thirds of adults were moved to lower-risk categories and one-third to higher-risk categories.
Men, Black individuals, and current smokers were most frequently reassigned downward in risk, while women and individuals with diabetes were more often reassigned upward. For patients, the practical next step is to ask whether a PREVENT score places them in the 3% to less than 5% range or the 5% to less than 10% range, because those cutoffs now shape whether statins are considered.
