J Clin Lipidol. 2026 May 26:S1933-2874(26)00359-4. doi: 10.1016/j.jacl.2026.05.224. Online ahead of print.
ABSTRACT
The 2026 American College of Cardiology (ACC)/American Heart Association (AHA)/Multisociety Guideline on the Management of Dyslipidemia (2026 Guideline) replaces the 2018 AHA/ACC/Multisociety Guideline on the Management of Blood Cholesterol. The 2026 Guideline expands the section on the management of hypertriglyceridemia (HTG) and acknowledges that triglyceride (TG)-rich lipoproteins contribute to atherosclerotic cardiovascular disease (ASCVD) risk. The 2026 Guideline emphasizes lifestyle interventions as the foundation of HTG management and recommends risk-based pharmacologic interventions for prevention of both ASCVD and pancreatitis. Nutritional interventions, preferably provided as medical nutrition therapy by registered dietitian nutritionists (RDNs), should be individualized based on underlying causes and degree of TG elevation. Referral rates to RDNs have been historically low, in part due to lack of awareness by providers and patients, and in part due to lack of RDN availability and lack of payer coverage. The 2026 Guideline emphasizes the importance of RDN involvement in care, especially for complex patients. Pharmacologic management requires initial and ongoing assessment of risk of ASCVD and pancreatitis, as well as modifications in therapy as appropriate. When TGs are ≥500 mg/dL, and especially ≥1000 mg/dL, preventing pancreatitis is the primary concern. Patients should be reassessed for ASCVD risk once TGs are reduced. Shared decision-making is critical to these discussions of lifestyle and pharmacologic interventions. Implementation of these recommendations necessitates clinician and patient education, as well as improvements in access and coverage for RDN involvement and combination pharmacotherapy, to enhance care of patients with HTG and reduce their risks of ASCVD and pancreatitis.
PMID:42270500 | DOI:10.1016/j.jacl.2026.05.224