Millions of New Patients Eligible for Statins Under 2026 AHA/ACC Guidelines

In light of recent recommendations from the American Heart Association (AHA) and the American College of Cardiology (ACC), among other organizations, >50% of all US adults between the ages of 30-79 are recommended for statins to prevent cardiovascular disease, according to recent research.¹

The 2026 updated recommendations include 5 central changes for primary prevention of atherosclerotic cardiovascular disease (ASCVD), which may substantially impact statin eligibility. These include an expansion of the population target for ASCVD from 40-75 years to 30-79, the addition of stage 3 or higher chronic kidney disease (CKD) and HIV infection as indications for eligibility separate from ASCVD risk, lowering thresholds for ASCVD risk, increasing statin initiation to class IIA, and recommending the PREVENT equations to replace the pooled cohort equations (PCEs) for 10-year ASCVD risk estimation.²

“The shift to a longer view of cardiovascular disease risk is a sea change for doctors in counseling patients,” Timothy Anderson, MD, MAS, assistant professor of medicine at Pitt and a lead investigator on the study, said in a statement. “We wanted to better understand the potential population-health effect of the shift.”¹

Anderson and colleagues analyzed participants from the 2017-2018, 2019-2020, and 2021-2023 cycles of NHANES, including those aged 30-79 who completed the mobile examination center visit while fasting. Adults with self-reported ASCVD or those missing laboratory or physical examination data used in the PREVENT equations were excluded.²

The team utilized both the PCEs and PREVENT equations to calculate patients’ 10-year ASCVD risk. The 30-year PREVENT-ASCVD risk was also included for patients 30-59 years. The PCEs included inputs for race, sex, age, total and HDL cholesterol levels, systolic blood pressure, antihypertensive medication use, diabetes, and smoking status. The PREVENT equations used similar inputs, only replacing race with estimated glomerular filtration rate and statin use.²

The study ultimately included 4366 participants from NHANES, representative of 154.5 million US adults (95% CI, 141.2-167.8) without known ASCVD. Patients’ mean age was 51 years, and 52% of patients were female. Among the estimated 154.5 million US adults, 17.8% reported currently taking statins, 8.6% met criteria for statin eligibility regardless of ASCVD risk based on LDL-C of ≥190 mg/dL, diabetes, or CKD, 5.5% had LDL-C <70 mg/dL, 2.3% met criteria for statin eligibility through LDL-C ≥190 mg/dL, 5% through diabetes, and 1.3% due to CKD. Anderson and colleagues concluded that roughly 68% (95% CI, 65.9-70%) met guideline criteria for ASCVD risk estimation to guide statin decisions.²

Among the estimated 105.1 million adults, 3.2 million were high risk, 11.4 were intermediate risk, 12.9 million were borderline risk, and 77.6 million were low risk. Among the low-risk portion, 5.4 million met eligibility criteria through LDL-C of 170-189 mg/dL, 13.7 million through 30-year risk ≥10%, and the remaining 58.5 million did not meet eligibility criteria. This brought total eligibility to 56.6% (95% CI, 54.2-58.9%) of the cohort, or roughly 87.5 million (95% CI, 80.4-94.5) US adults aged 30-79 years.²

“Ultimately, in this grey zone, patients should talk to doctors,” Anderson said. “This is a preference-based decision that should take into account the potential for modest cardiovascular risk reduction alongside the potential for adverse drug events, costs, and patient preferences.”¹

References

1. University of Pittsburgh. More than half of U.S. adults now eligible for statins under new guidelines, Pitt Study finds. Eurekalert. July 20, 2026. Accessed July 20, 2026. https://www.eurekalert.org/news-releases/1136297

2. Anderson T, Wilson L, Sussman J. Implications of the 2026 Dyslipidemia Guideline for Primary Prevention Statin Therapy. JAMA. July 20, 2026. Accessed July 20, 2026. doi:10.1001/jama.2026.11246