The new 2026 cholesterol guideline from the American Heart Association and American College of Cardiology expands eligibility for cholesterol‑lowering therapy to more than half of U.S. adults, according to a recent Epic Research study.
Eligibility jumped dramatically.
Eligibility jumps from 41% to 55% of adults
Researchers examined records of over 21 million adults aged 20 to 79 who had cholesterol testing and an outpatient visit between March 2025 and February 2026. None of the patients had a prior atherosclerotic cardiovascular disease event. Applying the 2018 and 2026 guidelines to the same dataset, they found eligibility rose from 41.3% under the older rule to 54.6% with the new one.
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The rise reflects three key changes in the 2026 guideline: the 10‑year risk threshold for treatment dropped from 7.5% to 3%; the eligible age range now includes people 76 to 79; and chronic kidney disease and HIV were upgraded from risk modifiers to direct qualifiers for therapy. The new risk calculator, called PREVENT‑ASCVD, also adds kidney function and current statin use as inputs while removing race as a factor.
Who gained and who lost eligibility
Overall, 40.7% of the cohort qualified under both sets of rules, while 13.9% became newly eligible under the 2026 version. Only 0.6% lost eligibility that they previously had.
Among the newly eligible, women were over‑represented at 66.4% compared with 57.9% in the total sample, and adults aged 70 to 79 made up 36.1% versus 15.8% overall. This mirrors the guideline’s broader age range and the inclusion of chronic kidney disease as a standalone condition.
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Conversely, the small group that lost eligibility was predominantly male (79.6%) and included a higher share of Black patients (47.5%). Half of that group fell in the 50‑to‑59 age bracket, a contrast to the 21.3% share in the full cohort.
Earlier analyses showed the PREVENT‑ASCVD equations tended to assign lower 10‑year risk scores to certain demographic groups, especially Black adults, because race is no longer a variable. Still, every subgroup studied saw an increase in eligibility. Men’s eligibility rose by 10%, while women’s grew by 16%. Age‑related gains ranged from under 1% for those 20‑29 to 32% for those 70‑79. The guideline’s lowered screening age from 40 to 30 also helped lift eligibility among adults 30‑39 by 15%.
The overall findings are based on real-world electronic health record data.
