Revised lipid-lowering therapy guidelines in a nationally representative sample - 20/08/26
Riassunto |
Background |
The 2026 ACC/AHA dyslipidemia guideline introduces PREVENT-based risk assessment, new direct-treatment pathways for comorbid conditions, and long-term risk estimation. The population-level effect of these changes on lipid-lowering therapy recommendations is unknown.
Objectives |
To compare classification of U.S. adults under the 2018 and 2026 dyslipidemia guidelines for treatment recommendations.
Methods |
Cross-sectional study of the National Health and Nutrition Examination Survey (2013-2023) including adults aged 40 to 75 years with data suitable for guideline classification. Individuals already receiving lipid-lowering therapy were classified separately. Treatment recommendation categories of ``recommended/indicated,'' ``reasonable/favored/selective-consideration,'' and ``not-routinely-recommended'' were constructed for cross-classification of untreated adults between the two guidelines.
Results |
The analytic cohort included 6,118 adults representing 118.9 million U.S. adults; 1,984 (weighted, 36.0 million [30.3%]) were already receiving lipid-lowering therapy. Among 4,134 untreated adults (82.9 million), the 2026 guideline classified 1,868 (31.2 million [37.7%]) as recommended/indicated, 1,154 (27.1 million [32.7%]) as reasonable/favored/selectively-considered, and 1,112 (24.6 million [29.7%]) as not-routinely-recommended. Under the 2018 guideline, corresponding counts were 1,289 (21.2 million [25.6%]), 1,107 (21.2 million [25.6%]), and 1,738 (40.5 million [48.9%]). All adults recommended/indicated under the 2018 framework remained so under the 2026 framework, 45.5% of those in the 2018 reasonable stratum moved to the 2026 recommended/indicated stratum, and 39.9% of the previously not-routinely-recommended moved to a higher-intensity category. PREVENT-based pathways accounted for 33.4% of the 2026 recommended/indicated stratum.
Conclusions |
Under the 2026 dyslipidemia guideline, an additional 15.9 million (14.1-17.7) untreated Americans aged 40 to 75 years would be newly identified for treatment consideration. The updated guideline substantially reallocates untreated adults toward consideration for treatment.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : ACC/AHA, ASCVD, CAC, CI, CKD, eGFR, LLT, LDL-C, NHANES, PCE, PREVENT
Mappa
Vol 301
Articolo 107524- novembre 2026 Ritorno al numero
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