Precision Medicine for Lipids: The New US Guidelines for Dyslipidemia

The 2026 American College of Cardiology/American Heart Association Multisociety Dyslipidemia Guideline (1) represents a substantial step forward from prior recommendations and elevates the role of the clinical laboratory in atherosclerotic cardiovascular disease (ASCVD) risk prediction and management (Table 1). The new framing of the guideline from management of “cholesterol” to “dyslipidemias” represents the conceptual shift from a cholesterol-centric view toward one that considers all atherogenic particles. The most consequential change is the restoration of explicit LDL cholesterol (LDL-C) as a treatment goal and the incorporation of non-HDL cholesterol (non-HDL-C) as a coprimary goal. Because therapy is once again “treat to goal,” the analytical accuracy of LDL-C and related ASCVD risk markers has become more critical than ever. The 2018 guideline deemphasized strict LDL-C targets, focusing instead on statin intensity and percentage LDL-C reduction, even while acknowledging the core principle that “lower is better.” The 2026 guideline reverses this trend by restoring explicit LDL-C and, for the first time, non-HDL-C goals stratified by ASCVD risk. For very-high-risk patients with established ASCVD, the new goal is LDL-C < 55 mg/dL (1.4 mmol/L) and non-HDL-C < 85 mg/dL (2.2 mmol/L); for high-risk primary prevention (10-year PREVENT risk ≥10%),