198. Beyond LDL: The 2026 Guidelines Make Lp(a), ApoB & 30-Year Risk Essential
Darsh and Altamash unpack the first major ACC/AHA lipid update since 2018, now reframed as a dyslipidemia guideline expanding beyond LDL to include triglycerides, ApoB, and lipoprotein(a). They highlight earlier prevention, the new PREVENT risk calculator, return of numeric LDL and non-HDL targets, routine Lp(a) screening, stepwise therapy beyond statins, and greater use of CAC imaging. Using a “trucks and cargo” analogy, they clarify lipid markers, review therapies from statins to PCSK9 inhibitors and inclisiran, compare CTA vs CAC, and explain why most supplements show no benefit.
TOPICS COVERED
• What changed in the new cholesterol guidelines
• Why earlier prevention matters for lifetime risk
• New PREVENT calculator for estimating risk
• Understanding LDL, ApoB, and “bad cholesterol” markers
• Lipoprotein(a): the genetic cholesterol risk to check once
• New LDL targets and when to treat more aggressively
• Medication options beyond statins
• When to use calcium score (CAC) scans
• CTA vs CAC: which heart scan to choose
• Do supplements actually help cholesterol?
RESOURCES & LINKS MENTIONED
ACC/AHA Dyslipidemia Guideline Update: https://www.acc.org/latest-in-cardiology/journal-scans/2026/03/13/15/20/acc-aha-release-new-clinical-guideline-for-managing-dyslipidemia
PREVENT Risk Calculator: https://professional.heart.org/en/guidelines-and-statements/prevent-calculator
Lipoprotein(a) [Lp(a)] Overview: https://www.heart.org/en/health-topics/cholesterol/genetic-conditions/lipoprotein-a
Apolipoprotein B (ApoB) Explanation: https://en.wikipedia.org/wiki/Apolipoprotein_B
Coronary Artery Calcium (CAC) Scan: https://www.mayoclinic.org/tests-procedures/heart-scan/about/pac-20384686
Coronary CT Angiography (CTA): https://www.mayoclinic.org/tests-procedures/ct-coronary-angiogram/about/pac-20385117
PCSK9 Inhibitors Overview: https://en.wikipedia.org/wiki/PCSK9
REDUCE-IT Trial (Icosapent Ethyl/Vascepa): https://www.brighamandwomens.org/campaigns/physicians/reduce-it-clinical-trial
AHA Life’s Essential 8: https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8
SPORT Trial (supplements vs statin): https://www.jacc.org/doi/10.1016/j.jacc.2022.10.013
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