We’re all keenly aware of the role cholesterol plays in the development of arteriosclerosis. It forms the core, or the body, of arteriosclerotic plaques that appear in the inner lining of the arterial blood vessels. Cholesterol, then, is a very important factor in hardening of the arteries and lowering the cholesterol levels in our blood stream is a medical priority.
Statin drugs, HMG-CoA Reductase inhibitors, were invented to lower cholesterol, and they are good at what they do. As a result of aggressive treatment with statins, we have witnessed a significant reduction in fatal, and non-fatal, heart attacks, stroke, sudden death, and cardiovascular disease. Over the past 40+ years, which I call the Statin Era, the American Heart Association (AHA) and the American College of Cardiology (ACC) have issued guidelines for the management of cholesterol. These guidelines are based on the results of hundreds of scientific studies designed to determine what level of Cholesterol, LDL, and HDL were necessary to make a difference in cardiovascular disease statistics. The levels required to make an impact have repeatedly been revised downward as disease statistics evolve, and it is learned that more aggressive treatment is needed.
Recently, the coalition issued 2026 ACC/AHA dyslipidemia guidelines. For the first time, I can recall, patients were divided into 3 categories based on their medical situation. Those patients with no known cardiovascular disease were in the primary prevention group. Those patients with a family history of heart disease, high blood pressure, or a mild coronary calcium score fell in the moderate risk group. And patients with previous CV events and/or diabetes were in the high risk group.
LDL-C is the type of cholesterol that causes atherosclerotic plaques. It is, then, the levels of LDL-C that are targeted by the new guidelines. It is these levels of LDL-C that doctors are encouraged to use as treatment targets. They are as follows:
The Primary prevention group: LDL-C should be less than 100 mg/dL
The Moderate risk group: LDL-C should be less than 70 mg/dL
The High risk group: LDL-C should be less than 55 mg/dL
Anyone with known atherosclerosis should strive for LDL-C less than 55 mg/dL
To reach these target levels of LDL-C, High intensity lipid therapy is recommended. High intensity treatment is represented by 20 mg of rosuvastatin, or 40 or 80 mg atorvastatin, plus ezetimibe (Zetia). These drugs should achieve a 50% reduction in LDL-C if the baseline level is around 120 mg/dL.
In addition to statins, et al., at every visit, doctors place heavy emphasis on lifestyle changes. Exercise, weight loss, and smoking cessation are just some of those important items.
Lowering the LDL-C to 55 mg/dL can be difficult, but studies show serious CV problems occur at levels above 55, so doctors are obligated to make an effort. Have your lipid panel done and get to work on your LDL-C. It will make a difference.
Reference: O’Donoghue ML, Blumenthal RS. New Lipid Guidelines: A User’s Guide Medscape 2026 April 2.
