JAMA, the Journal of American Medicine, just came out with the new “Lipid Lowering Guidelines” in 2026. There are changes to what they are advocating, so for those of you who tune out during the airline safety talk because you already know it, this is one NOT to tune out for. These are updated from guidance in 2018 based on a multitude of new studies, a new cardiovascular risk calculator, recalibrating risk categories, testing everyone for Lipoprotein A (the genetic risk factor), and making LDL targets lower.
Takeaways from the new lipid guidelines in 2026?
TEST EARLIER.
- There seems to be a cumulative exposure risk to elevated LDL-C levels
- All children should be screened around age 10 to identify familial hypercholesterolemia
- Everyone needs to test for lipoprotein A once. This is the genetic factor that increases your heart disease risks. (125 nmol/L = 1.4X risk, 250 nmol/L = 2X risk, 430 nmol/L = 4X risk)
- They recommend starting lipid profiling in adults at age 19
- Repeat the panel every 5 years, but more often if you have more risk factors
TREAT EARLIER
Start statins at age 30 for patients with LDL-C over 160 mg/dl, a strong family history of premature heart/stroke issues, or a high 30 year risk (even if your 10 year risk is low)
RISK CALCULATOR
They use the PREVENT risk calculator released in 2023. It looks at gender, BMI, systolic blood pressure, your total cholesterol, HDL cholesterol, your GFR (seen on your labwork in the kidney section), diabetes, smoking, if you are on meds for cholesterol. It gives you your 10 and 30 year risk.
You are considered low risk if less than 3%, Borderline risk 3-5%, and High Risk 10% or higher. So if you are at 5% risk, there is evidence these patients will benefit.
BORDERLINE? THESE ARE RISK ENHANCERS
There are some considerations which may put you at higher risk that are not in the calculator.
- Early menarche
- Early menopause (before age 45)
- Polycystic ovary syndrome
- Adverse pregnancy outcomes- gestational diabetes, hypertensive disorders, preterm delivery
- Ethnicity: Filipino, South Asian
- Family: Parent or sibling with premature heart disease, high Lp(a), high LDL, High triglyceride, high c reactive protein, or a chronic inflammatory condition
What is your cholesterol goal?
These are goals for LDL-C. (They do not include ApoB in their calculations, which has been shown to be more accurate, but is not in the calculations and recommendations published)
- < 100 mg/dL : No clinical issues, low or borderline risk on PREVENT calculator
- < 70 mg/dL: No clinical issues, high risk on PREVENT
- < 55 mg/dL: Patients with clinical disease.
ApoB
Updated guidelines are just starting to acknowledge ApoB as being a perhaps better metric. “A patient’s ApoB represents their total number of atherogenic particles- LDL, VLDL, and Lp(a).” It is not affected by fasting. They find this useful particularly for those with high triglycerides, Type 2 diabetes, or those with cardiovascular disease. Your ideal goal? ApoB below 90. Even lower may help reverse damage. See our blogs on ApoB
How can Biohackr Health help?
KNOW YOUR RISK. We offer testing with a comprehensive cholesterol panel, including Lipoprotein A and ApoB. We can test C reactive protein. We also can have you do a cardiac calcium scan. tests
TREAT BLOOD SUGAR. Again, we offer testing. But there are other things like losing weight, GLPs, continuous glucose monitors, and more. Pre diabetes and diabetes put you at higher heart disease risk, just like cholesterol. It is another thing to evaluate. Don’t wait until you are diabetic. There are interventions you can do earlier which will help. Tests GLP
BUILD MUSCLE. We love our NAD and Creatine. Know your current muscle percentage with an InBody scan. SHOP
SEE WHAT YOUR LUNGS AND HEART ARE DOING WITH A VO2 MAX TEST. This tests your lungs, heart, and muscle function and is a great barometer of health and longevity. When discussing heart disease risk, cholesterol is only one facet. VO2 max