Overview
- ACC/AHA multisociety guidance formally adopts the PREVENT-ASCVD equations for adults 30–79, with treatment consideration beginning at 3%–<5% 10-year risk and stronger consideration at 5%–<10%.
- The guideline reinstates explicit lipid targets by risk tier: LDL thresholds of <100 mg/dL, <70 mg/dL and <55 mg/dL with corresponding non-HDL and apoB goals.
- One-time lipoprotein(a) testing is recommended for all adults, apoB can guide therapy in select patients, and coronary artery calcium scanning is advised to reclassify borderline or intermediate risk.
- Ezetimibe, PCSK9 monoclonal antibodies, and bempedoic acid are elevated as adjuncts to statins, inclisiran carries a weaker recommendation, and dietary supplements are discouraged for lipid lowering.
- Screening moves earlier with lipid checks starting in youth and regular adult re-testing; in adults 30 and older, statins may be considered for LDL ≥160 mg/dL or elevated long-term risk using PREVENT.