What guideline-based care looks like

The 2026 dyslipidemia guideline sets LDL goals of 55, 70, or 100 by risk, uses the PREVENT calculator, checks Lp(a) once in a lifetime, and adds non-statin medicines sooner when a statin alone is not enough.

• ACC / AHA and 9 partner societies (incl. NLA, ASPC, ADA) · 2026

  Replaces the 2018 cholesterol guideline (published March 13, 2026)

  2026 ACC/AHA Multisociety Guideline on the Management of Dyslipidemia

  • Number goals are back: LDL under 55, 70, or 100 mg/dL depending on your risk, with matching non-HDL goals of under 85, 100, or 130.
  • Risk is now estimated with the AHA PREVENT calculator, which gives 10-year and 30-year risk, does not use race, and includes kidney function.
  • Everyone should have lipoprotein(a) measured once in adulthood; a high level raises risk even when LDL looks fine.
  • A coronary calcium scan is now a strong recommendation for men over 40 and women over 45 with borderline or intermediate risk; any calcium supports an LDL goal under 100.
  • If a statin alone does not reach the goal, add ezetimibe, bempedoic acid, or a PCSK9 inhibitor sooner rather than waiting. Inclisiran is an option mainly for people with heart disease who cannot use the other injectables.
  • Reported statin muscle symptoms usually have another cause: try a different statin or dose and combine with non-statin pills rather than stopping treatment.
  • Cholesterol care starts earlier: a cholesterol check for children ages 9 to 11, and medicine considered for young adults with LDL 160 or higher or a strong family history.
  • Over-the-counter supplements and fish oil pills are not recommended for lowering cholesterol. Prescription icosapent ethyl or fenofibrate may be considered for high triglycerides.
  • Pregnancy history now counts toward risk (preeclampsia, gestational diabetes, early menopause, PCOS), with dedicated guidance for older adults, kidney disease, and HIV.
  Read the guidelineDownload PDFdoi:10.1161/CIR.0000000000001423

• National Lipid Association · 2024

  NLA Scientific Statement on Lipoprotein(a): Use in Clinical Practice (2024 focused update)

  • Everyone should have lipoprotein(a), or Lp(a), measured at least once in their life. It is inherited and does not change much.
  • A high Lp(a) raises heart attack, stroke, and aortic valve risk on its own, so it moves people into a higher-risk group.
  • Until Lp(a)-lowering drugs finish trials, the treatment is tighter control of everything else, especially LDL and blood pressure.
  Read the guidelinedoi:10.1016/j.jacl.2024.03.001

• American College of Cardiology · 2022

  2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering

  • Explains when to add medicines beyond a statin: ezetimibe, PCSK9 antibodies, inclisiran, and bempedoic acid.
  • Sets LDL goals for the highest-risk patients (below 55 or below 70 depending on risk) and says to act when a goal is missed.
  • Gives a plan for people who cannot tolerate statins rather than leaving them untreated.
  Read the guidelinedoi:10.1016/j.jacc.2022.07.006

• US Preventive Services Task Force · 2022

  Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: USPSTF Recommendation Statement

  • Adults 40 to 75 with at least one risk factor and a 10-year risk of 10 percent or more should be offered a statin.
  • Those with 7.5 to 10 percent risk may benefit; it is a shared decision.
  • The evidence review found statins lower deaths, heart attacks, and strokes with no increase in serious harms.
  Read the guidelinedoi:10.1001/jama.2022.13044

• AHA / ACC and 10 partner societies · 2018

  Superseded by the 2026 dyslipidemia guideline; kept for reference

  2018 AHA/ACC Multisociety Guideline on the Management of Blood Cholesterol

  • A heart-healthy lifestyle is the base for everyone, at every age.
  • People who already have heart disease, very high LDL (190 or more), or diabetes should be on a statin. For others, a 10-year risk score plus a conversation decides.
  • If LDL stays high on the strongest statin dose you tolerate, ezetimibe and then a PCSK9 inhibitor are added for the highest-risk patients.
  • A coronary calcium scan can settle the question when the decision is unclear.
  • LDL should be rechecked 4 to 12 weeks after any change, then every 3 to 12 months.
  Read the guidelineDownload PDFdoi:10.1161/CIR.0000000000000625

Accurate measurement, home readings, lifestyle change, and medicines chosen from a short list of proven classes.

• AHA / ACC and 11 partner societies · 2025

  Replaces the 2017 ACC/AHA hypertension guideline

  2025 AHA/ACC Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

  • Normal is under 120/80. Stage 1 starts at 130/80 and stage 2 at 140/90; treatment goals are under 130/80 for most adults.
  • Blood pressure should be measured correctly (seated, rested, right cuff) and confirmed with home readings.
  • Lifestyle change comes first for everyone; medicines start sooner for people at higher risk, using thiazide-type diuretics, ACE inhibitors or ARBs, and calcium channel blockers.
  • Adds the PREVENT risk calculator and new advice on pregnancy, kidney disease, and brain health.
  Read the guidelineDownload PDFdoi:10.1161/CIR.0000000000001356

Four medicine classes, started early and together, cut deaths and hospital stays.

• American College of Cardiology · 2024

  2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction

  • A practical guide to starting all four heart failure medicines quickly, often within weeks, rather than one at a time over months.
  • Explains how to handle low blood pressure, kidney numbers, and potassium so medicines are adjusted rather than stopped.
  • Sets out when to refer to an advanced heart failure team.
  Read the guidelinedoi:10.1016/j.jacc.2023.12.024

• AHA / ACC / HFSA · 2022

  2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

  • For heart failure with reduced pumping (HFrEF), four medicine classes are recommended together: an ARNI (or ACE inhibitor or ARB), a beta blocker, an MRA, and an SGLT2 inhibitor.
  • Each of the four lowers death and hospital stays on its own; together the benefit is large.
  • SGLT2 inhibitors are also recommended for heart failure with preserved pumping (HFpEF), which had few options before.
  • Devices (ICD, CRT), cardiac rehab, and treating iron deficiency are covered for the right patients.
  Read the guidelineDownload PDFdoi:10.1161/CIR.0000000000001063

Risk scoring, shared decisions, and proven medicines for people with or at risk of coronary disease.

• AHA / ACC and partner societies · 2023

  2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease

  • For people living with coronary disease: statins, blood pressure control, antiplatelet therapy, and cardiac rehab are the foundation.
  • SGLT2 inhibitors and GLP-1 receptor agonists are recommended for many patients with diabetes and coronary disease.
  • Routine stress testing without symptoms is not recommended; testing follows symptoms.
  • Supplements such as fish oil, vitamins, and beta-carotene are not recommended to prevent heart events.
  Read the guidelineDownload PDFdoi:10.1161/CIR.0000000000001168

• ACC / AHA / ACCP / HRS · 2023

  2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation

  • Treats atrial fibrillation as a condition that progresses, so risk factors (weight, blood pressure, sleep apnea, alcohol) are managed early.
  • Blood thinners are chosen by stroke risk, and direct oral anticoagulants are preferred over warfarin for most people.
  • Catheter ablation can be a first-line rhythm treatment for selected patients.
  Read the guidelineDownload PDFdoi:10.1161/CIR.0000000000001193

• ACC / AHA · 2019

  2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

  • A team-based, shared-decision approach to preventing a first heart attack or stroke.
  • Covers diet, exercise (150 minutes a week of moderate activity), weight, tobacco, blood pressure, cholesterol, and diabetes.
  • Aspirin is no longer routine for prevention in most adults; it is reserved for selected people at higher risk and low bleeding risk.
  Read the guidelineDownload PDFdoi:10.1161/CIR.0000000000000678

The American standards update every year, and the UK NICE guidelines agree on the essentials: individual targets, glucose technology, and medicines that also protect the heart and kidneys.

• American Diabetes Association · 2026

  Standards of Care in Diabetes, 2026

  • The ADA updates this guideline every year; it is the reference most US diabetes care follows.
  • A1C goals are individualized (under 7 percent for many adults), with continuous glucose monitors recommended for anyone on insulin.
  • For people with heart disease, heart failure, or kidney disease, SGLT2 inhibitors and GLP-1 receptor agonists are recommended regardless of A1C.
  • Weight management, blood pressure, statins, kidney checks, eye and foot exams, and vaccines are part of routine care.
  Read the guideline

• KDIGO · 2022

  KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease

  • For people with both diabetes and kidney disease: an ACE inhibitor or ARB, an SGLT2 inhibitor, metformin if kidney function allows, and a statin.
  • Finerenone is added for those with albumin in the urine despite those medicines.
  • GLP-1 receptor agonists are preferred when more glucose lowering is needed.
  Read the guidelineDownload PDFdoi:10.1016/j.kint.2022.06.008

• NICE (United Kingdom) · 2022

  NICE NG28: Type 2 diabetes in adults: management

  • The UK national guideline, written by the National Institute for Health and Care Excellence and updated in 2022.
  • Individual A1C targets (usually 48 mmol/mol, about 6.5 percent, on lifestyle or one medicine; 53, about 7 percent, on medicines that can cause lows).
  • Metformin first; an SGLT2 inhibitor is added, or used first, for people with heart failure, heart disease, or high heart risk.
  • Covers blood pressure, foot and eye checks, kidney protection, and when to refer.
  Read the guidelineDownload PDF

• NICE (United Kingdom) · 2022

  NICE NG17: Type 1 diabetes in adults: diagnosis and management

  • Offers continuous glucose monitoring to all adults with type 1 diabetes and supports insulin pumps and hybrid closed-loop systems for those who qualify.
  • Recommends structured education (such as DAFNE) within a year of diagnosis and an A1C target of 48 mmol/mol, about 6.5 percent, where it can be reached safely.
  • Sets out ketone testing, sick-day rules, and how to spot and manage hypoglycemia.
  Read the guidelineDownload PDF

Find it early with two simple tests, then slow it with a handful of proven medicines.

• KDIGO · 2024

  KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

  • Kidney disease is found and staged with two tests: eGFR from a blood test and albumin in a urine sample.
  • SGLT2 inhibitors are recommended for most adults with CKD, with or without diabetes, because they slow kidney decline and protect the heart.
  • ACE inhibitors or ARBs for people with protein in the urine, statins for most adults with CKD, and blood pressure control are core treatments.
  • Referral to a nephrologist is advised at eGFR under 30, heavy protein loss, or rapid decline.
  Read the guidelineDownload PDFdoi:10.1016/j.kint.2023.10.018

Obesity is a chronic disease treated with lifestyle care, approved medicines, and surgery when appropriate.

• American Gastroenterological Association · 2022

  AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity

  • Reviews the trial evidence for each FDA-approved weight-loss medicine and recommends them, with lifestyle care, for adults with obesity.
  • Semaglutide and other GLP-1-based medicines showed the largest weight loss; phentermine-topiramate, naltrexone-bupropion, and others are also supported.
  • Recommends against orlistat for most patients because of small benefit and side effects.
  Read the guidelinedoi:10.1053/j.gastro.2022.08.045

• Endocrine Society · 2015

  Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline

  • Anti-obesity medicines are appropriate for people with BMI 30 or more, or 27 or more with a weight-related condition, alongside lifestyle care.
  • Only FDA-approved medicines should be used, and a medicine that has not produced 5 percent weight loss by 12 weeks should be stopped or changed.
  • Explains which common medicines for other conditions cause weight gain and what to switch to.
  Read the guidelinedoi:10.1210/jc.2014-3415

• AHA / ACC / The Obesity Society · 2013

  2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults

  • Losing 5 to 10 percent of body weight meaningfully improves blood pressure, cholesterol, and blood sugar.
  • A structured lifestyle program (diet, activity, behavior support) for at least 6 months is the foundation.
  • Bariatric surgery is an option for BMI 40 or more, or 35 or more with a weight-related condition.
  Read the guidelineDownload PDFdoi:10.1161/01.cir.0000437739.71477.ee

FDA-approved hormone therapy is safe and effective for most healthy women under 60 or within 10 years of menopause. Compounded hormones and pellets are not recommended.

• The Menopause Society · 2023

  Subscription may be required

  The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society

  • For women who cannot or prefer not to use hormones: cognitive behavioral therapy, hypnosis, certain antidepressants, gabapentin, oxybutynin, and fezolinetant are supported.
  • Not recommended because the evidence does not show benefit: supplements such as black cohosh, soy isoflavones, and cannabinoids, plus paced breathing, chiropractic, and 'cooling' techniques.
  Read the guidelinedoi:10.1097/GME.0000000000002200

• The Menopause Society (formerly NAMS) · 2022

  Subscription may be required

  The 2022 Hormone Therapy Position Statement of The North American Menopause Society

  • Hormone therapy is the most effective treatment for hot flashes and night sweats and prevents bone loss.
  • For healthy women under 60 or within 10 years of menopause, benefits outweigh risks for most.
  • Dose, type, and route should be individualized; there is no set time limit if benefits continue.
  • Compounded 'bioidentical' hormones and pellets are not recommended; FDA-approved products, including bioidentical estradiol and progesterone, are.
  Read the guidelinedoi:10.1097/GME.0000000000002028

The schedules pediatricians follow, with the timing that clinical trials and decades of monitoring support.

• American Academy of Pediatrics · 2026

  AAP Recommended Childhood and Adolescent Immunization Schedule

  • The schedule pediatricians on this site follow, covering birth through age 18.
  • Timing is based on when each vaccine works best and when the disease is most dangerous, tested in trials and monitored for decades.
  • Spreading vaccines out or delaying them leaves children unprotected longer and is not supported by evidence.
  Read the guideline

• CDC / ACIP · 2026

  CDC Child and Adolescent Immunization Schedule by Age

  • The federal schedule, with catch-up tables and notes for children with medical conditions.
  • Where federal and AAP recommendations differ, clinicians on this site follow the AAP and specialty-society guidance.
  Read the guidelineDownload PDF

• CDC / ACIP · 2026

  CDC Adult Immunization Schedule by Age

  • Which vaccines adults need and when: flu, COVID-19, Tdap, shingles, pneumococcal, RSV, HPV, hepatitis B, and others by age and condition.
  • People with heart, kidney, lung disease, or diabetes have extra recommendations because infections hit them harder.
  Read the guidelineDownload PDF

After a stroke or TIA, blood pressure, cholesterol, antiplatelet, and rhythm care prevent the next one.

• AHA / ASA · 2021

  2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

  • After a stroke or TIA, the cause should be found (heart rhythm, narrowed arteries, clotting) because treatment depends on it.
  • Blood pressure under 130/80, a high-intensity statin with LDL under 70, antiplatelet or anticoagulant medicine, and diabetes control prevent most repeat strokes.
  • Lifestyle: quit smoking, Mediterranean-style diet, activity, and limiting alcohol.
  Read the guidelineDownload PDFdoi:10.1161/STR.0000000000000375

Treat-to-target care for rheumatoid arthritis and gout.

• American College of Rheumatology · 2021

  2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

  • Methotrexate is the first medicine for most people with active rheumatoid arthritis, aiming for low disease activity or remission.
  • If the target is not reached, a biologic or targeted synthetic DMARD is added rather than switching among older drugs.
  • Long-term steroids are discouraged; they are for short bridges only.
  Read the guidelinedoi:10.1002/art.41752

• American College of Rheumatology · 2020

  2020 American College of Rheumatology Guideline for the Management of Gout

  • People with frequent flares, tophi, or joint damage should be on urate-lowering therapy, allopurinol first.
  • Treat to a uric acid target under 6 mg/dL, adjusting the dose until you get there, and continue long term.
  • Flares are treated with colchicine, NSAIDs, or steroids; anti-inflammatory cover is used when starting urate-lowering medicine.
  Read the guidelinedoi:10.1002/art.41247