Projected impact of 2026 ACC/AHA/Multisociety Dyslipidemia Guideline on lipid-lowering therapy eligibility based on Class 1 and 2a recommendations

BACKGROUND The 2026 American College of Cardiology/American Heart Association/Multisociety Dyslipidemia Guideline introduced pivotal changes to lipid-lowering therapy (LLT) eligibility compared with the 2018 Guideline. OBJECTIVE We aimed to compare eligibility for Class 1 and 2a LLT indications in the United States between the 2018 and 2026 Dyslipidemia Guidelines. METHODS We utilized National Health and Nutrition Examination Survey 2011-2018 datato evaluate LLT eligibility among participants aged ≥20 years, excluding pregnant women. Population weighted estimates were generated by indication and by demographic characteristic. RESULTS Under the 2026 Guideline, 102.9 million adults (46.8%, 95% CI: 45.0-48.6) would be eligible for LLT, including 65.3 million (29.7%, 95% CI: 28.0-31.4) with a Class 1 indication and 37.6 million (17.1%, 95% CI: 15.8-18.4) with a Class 2a indication, compared with 65.3 million adults (29.7%, 95% CI: 28.1-31.3) under the 2018 Guideline, including 60.2 million (27.4%, 95% CI: 25.8-28.9) and 5.1 million (2.3%, 95% CI: 2.0-2.7), respectively. The increase in eligibility was primarily driven by 2 additional Class 2a indications introduced in the 2026 Guideline: individuals with borderline Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) risk (previously classified as Class 2b) and adults aged 30 to 59 years with low PREVENT risk but elevated low-density lipoprotein cholesterol or elevated 30-year atherosclerotic cardiovascular disease risk. CONCLUSION Future studies should assess whether expanded eligibility improves LLT use and cardiovascular outcomes.