The American Heart Association and the American College of Cardiology always seem to be connected at the hip when it comes to guidelines and recommendations for the treatment of hyperlipidemia and for assessing the risk to Americans for developing atherosclerotic cardiovascular disease (ASCVD). Not too long ago, they jointly announced the lowering of target levels for the treatment of LDL-Cholesterol. The new recommendations are to lower the LDL-C to 55 mg/dl or less for diabetics and patients with known ASCVD, called high risk. For moderate risk patients, the new level was 70 mg/dl or less. For primary prevention the LDL-C was now 100 mg/dl.
Now, their latest recommendation is said to increase the number of patients eligible to take statins by 21.5 million US adults. That would mean that potentially 56.6% of patients aged 30-79 are candidates for statin therapy. Or in raw numbers, there are 87.5 million Americans who could, or should, be on a statin. I have no objection to this recommendation because the benefits of statin therapy are well-known, well-established, and very impressive. I’ve said for years that statins are relatively innocuous and should be in the water, but that has yet to happen.
How did the AHA/ACC make this huge increase occur? Well, statistics get stale after awhile, and if you don’t change how they’re calculated or presented, those of us who treat hyperlipidemia will lose interest. The new data were obtained from the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2023, but massaged a bit to expand the breadth of information. So researchers at Pittsburgh, Massachusetts General, and Johns Hopkins did two things; They extended the age group being assessed by 14 years to age 30 to 79, and lengthened the term of CVD risk assessment from 10 years to 30 years for some patients and lifetime for others.
These new limits opened up the scale of eligibity for statins because it included a lot of new people. These new patients had hyperlipidemia, too, and other factors that increased their risk of ASCVD. It became obvious statins were being underutilized, and broadening their risk of inclusion criteria will produce the same benefits for the new patients as were realized by prior patients.
Statin eligibility increases with age. For example, 11.1% of adults aged 30-39 and 93.5% of adults aged 70-79 are candidates for statin therapy. Of the recent increase in numbers of eligible adults, the largest increase occurred in the 50-59 age group—a 26.6% increase.
Additionally, the new target levels for LDL-C add another huge group of folks who should be on a statin. An evaluation at Mass. General Hosp showed that 32.2% of US adults had LDL-C levels above the new target numbers. That adds a huge number of people who need more aggressive statin dosing.
It would be much better for the population of American adults for municipalities to “statin-ize” the local water supply. Then everybody would realize the benefits of statins. This would be bigger than fluoridation which has been in place for over 70 years. Who knows how big the impact of this would be.
References: Brauser D. New Guidelines Expand Statin Eligibility to More Than half of US Adults. Medscape 2026 July 24.
Anderson TS, Wilson LM, Sussman JB. Implications of the 2026 Dyslipidemia Guideline for Primary Prevention statin Therapy. JAMA 2026 July 20:10.1001 JAMA.2026.i11246.
