More Than Half of U.S. Adults Eligible for Statin Therapy Under New Guidelines

• The AHA, ACC, and other medical organizations released new cholesterol guidelines in 2026.
• Three studies evaluated the potential impact of the new guidelines and found that they could expand treatment options.
• With more than half of U.S. adults eligible for statin therapy under the new guidelines, experts say early intervention is key to cholesterol management.
• A comprehensive approach to treating high cholesterol is recommended, including lifestyle changes and medication, if needed.

The American Heart Association (AHA), American College of Cardiology (ACC), and several other medical organizations introduced the ACC/AHA/Multisociety Dyslipidemia Guideline in 2026.

The updated guidelines recommend treating high cholesterol earlier, measuring lipoprotein(a) at least once to identify inherited heart disease risk, and using a newer, more personalized calculator to estimate cardiovascular risk.

They also set lower LDL (“bad”) cholesterol targets for people at very high risk of heart disease and encourage tailoring treatment based on individual risk factors and imaging when appropriate.

Now, three studies have examined the potential impact of the guidelines.

Collectively, they found that the changes to the guidelines could expand treatment eligibility and improve cholesterol control among U.S. adults.

Gaps in cholesterol management across U.S. adults

A study published in JAMA on July 20 examined cholesterol levels among U.S. adults using data from the 2021-2023 National Health and Nutrition Examination Survey (NHANES).

Researchers evaluated how many adults had LDL cholesterol levels above the 2026 guidelines’ goals, taking into account each person’s heart disease risk.

The findings showed that about one-third of adults without heart disease had LDL cholesterol above recommended levels, with the proportion increasing sharply with higher risk categories:

• 10% among low risk individuals
• 64% among those at borderline or intermediate risk
• 83% among high risk individuals

Among adults with established heart disease, nearly 80% had LDL levels above the stricter targets.

Additionally, the study revealed that a large majority of those with LDL cholesterol above the goal were not receiving cholesterol-lowering medications.

Specifically, over three-quarters of high risk individuals in primary prevention were untreated, and more than one-third of those in secondary prevention (with existing heart disease) were not receiving therapy.

These treatment gaps highlight ongoing challenges in managing cholesterol effectively and preventing cardiovascular events.

56% of adults qualify for statins under new guidelines

A separate analysis published in the same issue of JAMA used NHANES data from 2017 to 2023 to estimate the effects of the 2026 guideline changes on eligibility for statin therapy.

Statins are a commonly prescribed cholesterol-lowering medication for the primary prevention of heart attack or stroke.

The study found that the new guidelines significantly expand the number of U.S. adults who are recommended statins.

Approximately 56.6% of adults ages 30 to 79 years (about 87.5 million people) are now eligible for statins, including 21.5 million individuals who were not previously recommended statin therapy under the older 2018 guidelines.

The newly eligible group tends to be younger and at lower short-term risk, with an average predicted 10-year heart disease risk of just 3.1%, compared to 6.1% for those previously eligible. This change is partly due to the guidelines’ lowered risk thresholds and the inclusion of 30-year risk estimates for younger adults.

Statin eligibility varied by age: more than 93% of adults ages 70 to 79 and 85% of those ages 60 to 69 qualify for statins, while eligibility is much lower among adults ages 30 to 39 (about 11%).

The study also noted that among the newly eligible, many had other risk factors, such as:

• high cholesterol
• high blood pressure
• prediabetes
• obesity

The majority of adults currently taking statins continue to have a clear indication for therapy under the new guidelines, supporting continued treatment.

Shifts in risk assessment tools

A third study, also published in JAMA, explored how cardiovascular risk classification changes with the new PREVENT risk assessment tool.

The PREVENT-ASCVD risk tool is recommended over the older Pooled Cohort Equations (PCEs) in the 2026 guidelines.

Using NHANES data from 1999 to 2020, the study included adults ages 40 to 79 years without existing heart disease.

Researchers found that about 21.5% of adults were reclassified into different risk categories when using PREVENT instead of PCEs. Two-thirds of these individuals were moved to a lower-risk category, while one-third were moved to a higher-risk category.

Further, males, non-Hispanic Black individuals, and current smokers were more often reclassified downward, meaning their risk was estimated to be lower with the new tool. On the other hand, females and those with diabetes were more frequently reclassified upward.

Despite these shifts, the overall proportion of adults recommended for cholesterol-lowering therapy remained about the same.

The changes in risk categories allow for more personalized assessment and treatment decisions, including greater use of additional tests like coronary artery calcium scoring and consideration of risk-enhancing factors.

Early intervention matters for high cholesterol

Alexander Gutierrez, lead cardiac sonographer and department supervisor at Palmetto General Hospital in South Florida, and the founder of NightShiftQuant, said the 2026 guidelines present meaningful shifts in cholesterol management.

Specifically, he cited the restoration of specific LDL cholesterol targets and the recommendation on universal Lp(a) screening. Gutierrez wasn’t involved in the studies.

“As a cardiac sonographer who works daily in both adult and pediatric echo, I see firsthand what undertreated dyslipidemia does structurally: reduced ejection fraction, wall motion abnormalities from ischemic damage, and accelerated calcification of heart valves,” he told Healthline.

Elevated Lp(a) is one of the most underdiagnosed drivers of premature cardiovascular disease, according to Gutierrez, who also praised the fact that children are now being addressed by the guidelines.

“[F]amilial hypercholesterolemia starts at birth, and catching it early is where imaging and lipid screening intersect most powerfully,” he said.

Gutierrez further noted that many people may not realize they have high cholesterol.

“Patients feel fine until they don’t — and often the first time they truly understand their risk is when I am showing them their own heart on a screen,” he said, noting that this makes early intervention especially valuable.

A whole-health approach to cholesterol management

Sonal Chandra, MD, a preventive cardiologist and founder of Focus Cardiology, said that cholesterol should never be treated as a single lab value. Chandra wasn’t involved in the studies.

“Cardiovascular risk has always been a composite of multiple factors, including age, blood pressure, diabetes, kidney function, smoking, family history, cumulative exposure to elevated cholesterol, and evidence of existing plaque,” she told Healthline.

However, the emphasis on numbers among the general public has sometimes distracted from this.

“The updated guidelines are helpful because they formally reinforce a more comprehensive approach, but they are also catching up to what many patients and clinicians have understood for years: cardiovascular prevention requires treating the whole risk profile, not simply chasing one cholesterol number,” said Chandra.

Chandra noted the importance of employing both lifestyle measures and, if needed, medication to treat elevated cholesterol.

“A diet emphasizing vegetables, fruit, legumes, whole grains, nuts, seeds, unsaturated fats, and lean proteins; regular exercise; healthy weight management; adequate sleep; smoking cessation; and blood-pressure control remain foundational,” she said.

However, medication may still be necessary for some, even after following these recommendations.

“The decision should be thoughtful, individualized, and based on the patient’s overall cardiovascular risk, evidence of existing plaque, treatment goals, and personal preferences,” said Chandra.