Doctors have long encouraged patients to lower their LDL cholesterol, the so-called “bad” cholesterol that contributes to a buildup of plaque inside arteries. The newly released 2026 American College of Cardiology and American Heart Association cholesterol guidelines have moved the goalpost for LDL cholesterol, and as a result, millions of Americans are falling short of newly-recommended cholesterol goals.
A recent national study found that many Americans are at unnecessary risk for heart attack and stroke due to inadequate cholesterol management. The study, conducted by Mass General Brigham Hospital, looked at how Americans measure up against the new cholesterol guidelines and found a surprisingly wide gap between recommended LDL cholesterol levels and where many Americans’ levels actually stand.
The investigators used data from over 2,300 adults between the ages of 30 and 79 who participated in the National Health and Nutrition Examination Survey from 2021 through 2023. Because this survey is designed to represent the U.S. population, those participants reflect roughly 178 million American adults. They applied the new 2026 cholesterol guidelines to determine how many people would meet today’s recommended LDL cholesterol targets.
Unlike previous recommendations, the new guidelines tailor LDL cholesterol goals according to a person’s overall cardiovascular risk. The greater your risk of developing heart disease, or experiencing another cardiovascular event, the lower your LDL cholesterol should be. For instance, for someone at relatively low risk, treatment may be considered when LDL reaches 160 mg/dL or higher. But for folks who have already suffered a heart attack or stroke and are considered at very high risk, the recommended target is below 55 mg/dL.
Nearly one in three adults who never experienced a heart attack, stroke or other cardiovascular event, had LDL cholesterol levels above the new recommended goals. Even more concerning, about 75 percent of those individuals weren’t taking any cholesterol-lowering medication.
The picture was even more troubling among people who already had heart disease. Nearly four out of five of this population had LDL cholesterol levels above the new target. Most of them were already taking cholesterol-lowering medication, suggesting that while treatment had begun, it often wasn’t strong enough to achieve the more aggressive goals recommended by the new guidelines.
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According to lead author, Shady Abohashem, MD, MPH, Head of Cardiac PET/CT imaging Trials in the Cardiovascular Imaging Center at the Mass General Brigham Heart and Vascular Institute, the findings represent a major opportunity to prevent disease before it happens. Shady Abohashem noted that “heart disease remains a leading cause of death in this country, and a large share of heart attacks and strokes are preventable with medications we’ve had for decades. Yet many people who would benefit from treatment aren’t getting any.”
The study also established an important benchmark. Because the survey data were collected before the new guidelines were released, future research can determine whether cholesterol management improves as physicians and patients adopt the updated recommendations. In the meantime, the authors encourage people to know both their LDL cholesterol number and the goal that’s appropriate for their personal level of cardiovascular risk, which can be found on the American Heart Association website.
Cholesterol management is essential and one-size-fits-all is no longer appropriate. Reviewing cholesterol numbers with a healthcare provider could be a lifesaving conversation, especially for those at high risk of cardiovascular events.
In comparison to past guidelines, the new recommendations mark a significant shift towards more personalized and aggressive treatment of high cholesterol. This change is likely to have a substantial impact on public health, as it has the potential to prevent thousands of heart attacks and strokes each year. By tailoring treatment to individual risk levels, healthcare providers can better protect their patients from cardiovascular disease.
The study is published in JAMA, highlighting the need for increased awareness and action on cholesterol management. As the authors note, the gap between current cholesterol levels and the new guidelines is wider than expected, and addressing this gap could save countless lives.
Healthcare providers can help their patients by discussing the importance of managing cholesterol levels and the benefits of independent practice technology in achieving these goals.
