A special JACC Spotlight Issue supporting the recently published 2026 ACC/AHA Guideline on the Management of Dyslipidemia, offers commentaries that provide a comprehensive overview of the new guideline recommendations and expert insights into understanding the science behind the recommendations and implementing them in practice. Together these commentaries emphasize improved risk assessment, earlier and more personalized lipid-lowering strategies, thoughtful prevention and management for high-risk populations, including women and patients with obesity, and expanded use of tools such as the PREVENT equations and coronary artery calcium scoring along with apolipoprotein B (ApoB) and lipoprotein(a) (Lp[a]) measurements.

Issue highlights include:

In his Editor's Page Harlan M. Krumholz, MD, SM, MACC, discusses what he calls the "most important unsolved problem" with treating dyslipidemia. "Too many patients who could benefit greatly are not taking statins, for reasons the evidence does not support, reinforced by an information environment we have the power to change," he writes.

In the commentary, Dyslipidemia Guideline Development: Building a Robust Foundation, Roger S. Blumenthal, MD, FACC, and Pamela B. Morris, MD, FACC, chair and vice chair of the guideline writing committee, offer an inside look at the creation of the new guideline and review key updates and changes based on recent evidence. "Guideline development is an exhilarating and humbling process," they write. "Science moves at an extraordinary pace, evidence review demands rigorous attention to detail, achieving consensus requires compromise, and crafting evidence-based recommendations re quires precise grading of the science."

Seeing the Whole Picture: ApoB and Lp(a) in the 2026 Dyslipidemia Guideline is the focus of a commentary from Michael D. Shapiro, DO, FACC, that addresses the importance of expanding beyond LDL-C to incorporate ApoB and Lp(a) as key markers of atherogenic and inherited cardiovascular risk, and details the science supporting their use. "If LDL-C lowering was the first revolution in preventive cardiology," he writes, "the incorporation of ApoB and Lp(a) marks the beginning of the second, one rooted in particle biology, genetic risk, and refined precision prevention."

Erin D. Michos, MD, FACC, and Blumenthal address the advances in incorporating female-specific reproductive and hormonal risk factors into cardiovascular risk assessment in a commentary focused on Dyslipidemia in Women: Reproductive Factors and Risk Across the Life Course. With women remaining undertreated despite deriving similar benefit from lipid-lowering therapy (LLT), they highlight how the guideline "makes notable progress" by advancing a life course-oriented approach to prevention in women. "Adoption of these recommendations should improve timely initiation of LLT which is essential to reducing [atherosclerotic cardiovascular disease] risk," they write.

Adam J. Nelson, MBBS, and Neha J. Pagidipati, MD, FACC, turn their attention toward Obesity, Sedentary Behavior, and Dyslipidemia: Intersections That Matter. They provide a closer look at the "complex intersections" between these overlapping conditions and highlight specific recommendations within the new guideline to help assess, diagnose and manage dyslipidemia and cardiovascular risk in patients, ranging from physical activity, to weight management and LLT. "When it comes to physical activity, weight management, and LLTs in the context of dyslipidemia, the answer is 'all of the above' rather than 'either/or,'" they write.

In a commentary on LDL Cholesterol: How Low to Go?, Gregory G. Schwartz, MD, PhD, FACC, identifies "what specific LDL-C goal should be set for a broad swath of patients deemed to be at very high or high risk for ischemic cardiovascular events," as a "consequential question" in the management of dyslipidemia. He discusses the latest goals set forth by the guideline, which he considers "a judicious distillation of current evidence," building on the results of the IMPROVE-IT, FOURIER, ODYSSEY OUTCOMES, PROVE-IT, Ez-PAVE and other trials, and addresses further cardiovascular outcomes, care considerations and safety concerns.

Read all 21 viewpoints in this JACC Spotlight issue. Plus, visit the Dyslipidemia Guideline Hub to read the full guideline, its accompanying Guideline-at-a-Glance summary and access other clinical resources. Download ACC's new CVD Risk Estimator Plus app that combines the 2013 ACC/AHA Pooled Cohort Equations with the 2023 AHA PREVENT calculator to deliver a more complete view of 10‑ and 30‑year risk for total cardiovascular disease, ASCVD and heart failure, along with ACC's Guideline Clinical app to access all the guidelines anytime, anywhere.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Advanced Lipid Testing, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Acute Heart Failure

Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cholesterol, LDL, Apolipoproteins B, Dyslipidemias, Lipoprotein(a), Heart Failure, Obesity