Nearly 25 million more adults in the U.S. are eligible for statin therapy, based on recommendations in the 2026 ACC/AHA/Multisociety Dyslipidemia Guideline, compared with the previous guideline, according to original research published Aug. 12 in JACC. The largest increase in eligibility was among middle-aged adults with a low 10-year risk but elevated 30-year risk.

Using NHANES data from four survey cycles from 2011-2020, investigators analyzed a sample of 10,383 participants representing 233.1 million U.S. adults to estimate how many would be eligible for statin initiation under the 2026 Guideline, which adopted the new PREVENT-ASCVD risk calculator, reintroduced LDL-C treatment targets and emphasized incorporating 30-year ASCVD risk into treatment decisions even in the absence of short-term risk.

Results showed that 41% of U.S. adults without ASCVD who were not currently receiving lipid-lowering therapy (LLT) would be eligible for statin consideration under the 2026 Dyslipidemia Guideline, compared with 26% under the 2018 Guideline – representing nearly 25 million additional adults.

The largest driver of this increase was the new recommendation to consider statins in adults aged 30-59 years with elevated 30-year ASCVD risk despite low short-term risk. Among adults in this age group, 16 million had a 30-year ASCVD risk ≥10% despite a 10-year risk <3% – nearly double the number identified by 10-year risk assessment alone (8 million with ASCVD risk ≥3%).

"By introducing these recommendations, the 2026 guidelines shift focus from short-term risk reduction to cumulative lifelong benefit," write study authors Ahmed Sayed, MD; Eric D. Peterson, MD, MPH, FACC; and Ann Marie Navar, MD, PhD, FACC. "This move is built on evidence showing that cardiovascular risk is better reflected by cumulative risk factor exposure across a person's lifetime than by a singular measurement at an older age and that early statin initiation can reduce long-term risk."

"This new framework has the potential to engage millions of younger adults in earlier preventive care," adds Michelle L. O'Donoghue, MD, MPH, FACC, in an accompanying editorial comment. "The guideline's principal innovation is less about lowering treatment thresholds than about expanding the population for whom conversations about long-term cardiovascular prevention become appropriate."

Among adults already receiving treatment, investigators found that of the 39 million receiving LLT for a Class 1 indication, 79% remained above recommended LDL-C targets. In patients with established ASCVD, only 26% achieved LDL-C <70 mg/dL and just 9% achieved LDL-C <55 mg/dL.