Patient guide · High cholesterol
Cholesterol: what good care looks like
LDL cholesterol causes heart attacks and strokes, and lowering it with proven medicines prevents them. Here is what the guidelines recommend and how to know your care follows them.
What high cholesterol is, in plain language
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What the current guidelines recommend
The main guideline is the 2026 ACC/AHA Multisociety Guideline on the Management of Dyslipidemia (March 2026), which replaced the 2018 cholesterol guideline. Key points: LDL goals of under 55, 70, or 100 mg/dL by risk; the PREVENT risk calculator; Lp(a) measured once in a lifetime; calcium scoring for borderline risk; ezetimibe, bempedoic acid, or a PCSK9 inhibitor added sooner when a statin alone is not enough; no supplements or fish oil pills for cholesterol. **
The treatments, and why each one is recommended
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What guideline-based care looks like at a visit
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Red flags that a clinician is not following the guidelines
- Selling supplements, peptides, or compounded drugs as treatment
- Stopping proven medicines without a medical reason
- Ordering unproven tests or “detox” programs
- Telling you the guidelines are wrong without evidence
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Why choosing a guideline-based clinician matters
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Questions to ask your doctor
- Which guideline do you follow for high cholesterol, and what year is it from?
- Which of the recommended treatments am I on, and if not, why not?
- What targets are we aiming for, and how will we track them?
- What should make me call you before my next visit?
- Do you sell any supplements or compounded medicines? (A guideline-based clinic does not.)
Find a vetted lipidologist near you
Every lipidologist on DoctorDirectory.ai is license-verified, board-certified, and has signed a dated attestation to these guidelines. No patient reviews or star ratings, just facts you can check.
The guidelines behind this guide
Summaries in plain language, with links to the official documents and PDFs.
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.
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.2024.03.001American 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.2022.07.006US 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.2022.13044AHA / ACC and 10 partner societies · 2018
Superseded by the 2026 dyslipidemia guideline; kept for reference2018 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.
Find a vetted lipidologist near you
Every lipidologist listed has a verified license, board certifications on record, and a dated attestation to these guidelines. No reviews, no ratings.