More U.S. adults eligible for statins under updated guidelines

More than half of U.S. adults between the ages of 30 and 79—roughly 87.5 million people—may now meet criteria for statin therapy, according to a study published July 20 in JAMA. More than 20 million more adults became eligible for one of these commonly prescribed cholesterol-lowering drugs following a March 2026 update to guidelines on the management of high cholesterol by the American Heart Association, the American College of Cardiology and other organizations.

While healthy lifestyle changes are still the first step in managing cholesterol levels, the update lowers the age at which statin use may be considered to reduce lifetime risks and improve long-term outcomes. “We should consider adding lipid-lowering medication earlier than we would have considered 10 years ago,” said Roger Blumenthal, MD, FACC, FAHA, chair of the guideline writing committee, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and the Kenneth J. Pollin Professor of Cardiology at Johns Hopkins Hospital in Baltimore in a March 2026 news release. “And lower LDL cholesterol for longer, just like lower blood pressure for longer, results in much greater protection against future heart attack and stroke risk.”

Until now, doctors calculated patients’ 10-year risk of developing heart disease within the next 10 years. The updated guidelines broaden statin eligibility by recommending that they also consider the 30-year risk for those between 30 and 59 years old. So, if someone in that age group has a low 10-year risk, but a 30-year risk of 10 percent or more, a statin may be considered to prevent decades of cholesterol buildup.

Keep in mind, not everyone eligible for a statin may want or need to take one. Those eligible for these drugs should consider what is best for them under the guidance of their healthcare provider (HCP).

Taking a personalized approach

In the past, treatment for high cholesterol tended to be prescribed mostly on the basis of blood test results.. Starting in 2018, HCPs began looking at patients’ overall heart health and heart risk within a broader context when thinking about therapy options.

The latest 2026 update to cholesterol guidelines expands the focus from adults ages 40 to 75 to adults ages 30 to 79. They also lower the thresholds used to categorize cardiovascular risk. So, a 10 percent chance of having a heart-related event within 10 years is considered high risk, 5 percent is considered intermediate risk, and 3 percent is considered borderline.

While healthy lifestyle changes, such as not smoking, being physically active, following a healthy diet, maintaining a healthy weight, and getting enough quality sleep, remain the first step in protecting heart health, the updated guidelines also focus on:

Lower levels of “bad” low-density lipoprotein (LDL) cholesterol for some people. The rule of thumb is to keep your:

• Total cholesterol less than 200
• “Bad” LDL less than 130 (depending on your individual health history and risk factors, your LDL goal may be 70 mg/dL, or even 55 mg/dL)
• “Good” HDL (it absorbs cholesterol in the blood) more than 60
• Triglycerides less than 150

Earlier screenings, especially for those with a family history of heart disease and risk factors. In keeping with American Academy of Pediatrics recommendations, the guidelines on high cholesterol suggest an initial screening between the ages of 9 and 11 years old with a follow up by age 17 to 21. For children with a strong family history of heart disease or inherited high cholesterol, however, screening may begin as early as age 2.

HCPs are advised to contemplate additional “risk-enhancing factors” such as:

• Family history of early heart disease
• Ethnicity
• Conditions such as kidney disease or inflammatory diseases (such as psoriasis or rheumatoid arthritis), HIV
• History of premature menopause, gestational diabetes (diabetes during pregnancy, or preeclampsia
• A high level of lipoprotein (a), Lp(a). Lp(a) is a mostly inherited type of lipoprotein that carries cholesterol. High Lp(a) (50 mg/dL or greater) is linked to a higher long-term risk for heart attack or stroke. Adults should receive this screening at least once.
• A high level of high-sensitivity C-reactive protein (hsCRP). A level above 3.0 mg/L indicates a high risk for heart disease and active inflammation.

Additional tests, which may not be necessary for everyone, may be used in some cases to more clearly define heart-related risks, including:

Coronary calcium (CAC) scan: This is a special CT scan of the heart. It looks for calcium deposits in the arteries. Calcium is an important nutrient needed to build strong bones, but it also helps muscles contract, helps the heart beat, and helps nerves to signal. But when there’s a buildup of plaque in the arteries, calcium may also accumulate. A buildup of calcium can narrow the arteries and reduce blood flow to the heart. This CT scan helps estimate the chances that those arteries may someday become blocked, which could lead to a heart attack or stroke. A higher calcium score suggests that plaque is already present and may bolster the case to begin treatment.

Apolipoprotein B. ApoB is a protein that may contribute to the buildup of cholesterol in artery walls. This test may be used as third "goal" to achieve if other cholesterol goals have been met.

When statins are not enough

For some people at very high risk for heart disease, other cholesterol-lowering drugs may be used along with statins when statins alone are not enough to maintain healthy cholesterol levels. Ezetimibe, which blocks the absorption of cholesterol in the intestine is typically prescribed to be used in combination with a statin. PCSK9 inhibitors are also on the treatment menu. These drugs target and disable a liver protein called PCSK9 that allows excess LDL to stay in the blood.

Bempedoic acid is another medication that can help lower LDL cholesterol, particularly among those who cannot tolerate statins. It works by reducing cholesterol production in the liver, causing liver cells to pull more LDL cholesterol out of the blood.