CLINICAL INFORMATICS / EDUCATIONAL PREVIEW

LipidPathFrom evidence to understanding.

An interactive companion to the 2026 multisociety dyslipidemia guideline. Follow a supported adult pathway, inspect the evidence, and understand where individual assessment matters.

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Choose how much detail you prefer. Both views use the same clinical assessment.

Profile

Answer only the fields that apply. Unknown values remain unknown. Adults outside the supported scope receive a review message.

Atherosclerotic cardiovascular disease (ASCVD) means disease caused by plaque in arteries. A clinician may have diagnosed this after a heart attack, certain strokes, narrowed leg arteries or an artery procedure. Not every stroke or episode of chest pain qualifies; choose unknown if unsure.

Additional health and safety details

These details help determine which treatment discussions are appropriate. You can leave an answer unknown.

Optional unless applying CAC age criteria; the risk equation is calculated separately.

Includes a documented severe elevation before treatment. Unknown baseline must not be treated as a negative history.

Requires clinical confirmation of chronic disease; a single eGFR value does not establish CKD.

Active cancer treatment, significant frailty, limited life expectancy, or another major condition affecting medication choice.

Confirm a clinician reviewed relevant liver/kidney disease, medications and other contraindications. No selection implies no automatic treatment output.

Risk enhancers and family history

Premature ASCVD in close family; clarify with a clinician for CAC-zero decisions.

Evidence & pathway explorer

Evidence & pathway explorer

Original summaries with source locations, eligibility and evidence grades. COR = Class of Recommendation; LOE = Level of Evidence. A strong recommendation is not an individual prescribing order. All entries await independent clinical review.

Blumenthal et al. (2026). Guideline on the Management of Dyslipidemia. Circulation, 153, e1154–e1276. Read the authoritative guideline.

Coverage and limitations

Core adult primary/secondary prevention, severe LDL history, diabetes age 40–75, CAC with age eligibility, TG, Lp(a), apoB assessment and selected CKD/HIV indications are supported. Children, HoFH treatment, pregnancy/planning/lactation, dialysis, complex cancer care, detailed younger/older diabetes pathways, advanced statin rechallenge, automatic PREVENT and LDL estimation are deferred to individual review. ApoB goals and medication doses are not assigned.

Copyright ©2026 ACC Foundation and AHA for the source guideline. No guideline figures, tables, PDF or logos are redistributed. Simpyll is not affiliated with or endorsed by these organizations.

§4.2.3.2 · R1Use PREVENT-ASCVD to categorize eligible primary-prevention risk.

Eligibility: Age 30–79; LDL-C 70–189 mg/dL; no clinical or subclinical ASCVD.

Exceptions: General population equations excluded in FH. Use ASCVD outcome, not total CVD; 30-year horizon only age 30–59.

COR 1 · LOE B-NR · e1183–84 · Figure 5–6

Source guideline

Source mapped; independent clinical review pending.

§3.2 · R2Repeat a fasting lipid profile when a nonfasting triglyceride value is ≥400 mg/dL to improve LDL assessment.

Eligibility: Nonfasting TG ≥400 mg/dL.

Exceptions: Also applies with known/suspected TG disorders or relevant family history; laboratory method and clinical context require review.

COR 1 · LOE B-NR · e1166

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.7 · R1Discuss health behaviors alongside the benefits and risks of lipid treatment.

Eligibility: Adults assessed for primary prevention.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE A · e1192

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.7 · R3At low short-term risk, consider long-term exposure; LDL-C 160–189 or 30-year risk ≥10% supports discussing moderate statin therapy.

Eligibility: Age 30–59; 10-year risk <3%.

Exceptions: Lifestyle-only recommendation 2 requires LDL-C <160 AND 30-year risk <10%; missing long-term risk is not a negative result.

COR 2a · LOE C-LD · e1192 · Figure 6

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.7 · R4If a decision to treat is made, a moderate-intensity statin with approximately 30–49% LDL-C reduction is reasonable.

Eligibility: 10-year risk 3% to <5%.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 2a · LOE A · e1192 · Figure 6

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.7 · R5Discuss at least moderate-intensity statin therapy; high intensity can benefit those near the higher end of intermediate risk.

Eligibility: 10-year risk 5% to <10%.

Exceptions: No invented numeric cutoff within the intermediate range.

COR 1 · LOE A · e1192 · Figure 6

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.7 · R6When statin therapy is initiated, LDL-C <100 and non-HDL-C <130 mg/dL are reasonable goals.

Eligibility: Borderline or intermediate primary-prevention risk.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 2a · LOE B-NR · e1192 · Figure 6

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.7 · R7High-intensity statin therapy aims for at least 50% LDL-C reduction when lipid treatment is initiated.

Eligibility: Primary prevention; 10-year ASCVD risk ≥10%.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE A · e1192 · Figure 6

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.7 · R8If treating high primary-prevention risk, consider LDL-C <70 and non-HDL-C <100 mg/dL.

Eligibility: 10-year risk ≥10%; decision to treat.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 2a · LOE B-R · e1192 · Figure 6

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.7 · R9Consider adding ezetimibe when goals remain unmet on maximally tolerated statin.

Eligibility: High primary-prevention risk, maximally tolerated statin, unmet goals.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 2a · LOE B-R · e1192

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.7 · R10PCSK9 monoclonal antibody or bempedoic acid may be reasonable when goals remain unmet.

Eligibility: High primary-prevention risk on maximally tolerated statin with or without ezetimibe.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 2b · LOE B-NR · e1192

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.3 · R1Risk enhancers can personalize a borderline-risk benefit-risk discussion.

Eligibility: No ASCVD; 10-year risk 3% to <5%.

Exceptions: Do not numerically adjust a PREVENT result.

COR 2a · LOE B-NR · e1186

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.4 · R1Reproductive history may inform the prevention discussion.

Eligibility: Early menopause or adverse pregnancy outcomes; no ASCVD.

Exceptions: History is distinct from current pregnancy/planning/lactation.

COR 2a · LOE B-NR · e1188

Source guideline

Source mapped; independent clinical review pending.

§4.2.4.3 · R1Evaluate and address secondary causes of severe LDL elevation.

Eligibility: Severe untreated/history LDL-C ≥190 mg/dL.

Exceptions: Does not establish FH. Non-HDL/apoB-only severe phenotypes need individual review.

COR 1 · LOE B-NR · e1198 · Figure 7

Source guideline

Source mapped; independent clinical review pending.

§4.2.4.3 · R2Maximally tolerated statin is the foundation of severe hypercholesterolemia treatment.

Eligibility: Untreated/history LDL-C ≥190 mg/dL.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE B-R · e1198 · Figure 7

Source guideline

Source mapped; independent clinical review pending.

§4.2.4.3 · R3Consider nonstatin therapy on maximally tolerated statin to reach LDL-C <100 and non-HDL-C <130 mg/dL.

Eligibility: Severe LDL elevation without ASCVD, HeFH, additional risk factors or subclinical disease.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE B-NR · e1198 · Figure 7

Source guideline

Source mapped; independent clinical review pending.

§4.2.4.3 · R4With HeFH, additional ASCVD risk or coronary calcification, goals are LDL-C <70 and non-HDL-C <100 mg/dL.

Eligibility: Severe LDL elevation without clinical ASCVD, plus a qualifying risk condition.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE B-R · e1199 · Figure 7

Source guideline

Source mapped; independent clinical review pending.

§4.2.4.3 · R5With severe hypercholesterolemia and ASCVD, goals are LDL-C <55 and non-HDL-C <85 mg/dL.

Eligibility: Severe LDL elevation and clinical ASCVD; add-on therapy on maximally tolerated statin.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE B-R · e1199 · Figure 7

Source guideline

Source mapped; independent clinical review pending.

§4.2.4.3 · R6Inclisiran can be considered for LDL lowering when LDL-C remains ≥100 on maximally tolerated statin with or without ezetimibe.

Eligibility: Severe hypercholesterolemia.

Exceptions: Outcomes trials pending in this guideline; not equivalent to established outcome benefit. HoFH excluded.

COR 2a · LOE B-R · e1199

Source guideline

Source mapped; independent clinical review pending.

§4.2.5 · R1Discuss moderate statin therapy, 30–49% LDL reduction and goals below 100/130 mg/dL for LDL/non-HDL.

Eligibility: Diabetes age 40–75 without ASCVD.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE A · e1204 · Figure 9

Source guideline

Source mapped; independent clinical review pending.

§4.2.5 · R3With multiple ASCVD risk factors, high intensity and goals below 70/100 mg/dL with ≥50% LDL reduction are reasonable.

Eligibility: Diabetes age 40–75 without ASCVD and multiple ASCVD risk factors.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 2a · LOE B-R · e1204 · Figure 9

Source guideline

Source mapped; independent clinical review pending.

§4.2.6 · R1High-intensity statin therapy targets ≥50% LDL reduction and LDL/non-HDL below 70/100 mg/dL.

Eligibility: Clinical ASCVD not at very high risk.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE A · e1208 · Figure 10, 12

Source guideline

Source mapped; independent clinical review pending.

§4.2.6 · R2–3On maximally tolerated statin, discuss ezetimibe, PCSK9 monoclonal antibody or bempedoic acid; an optional lower goal is 55/85 mg/dL.

Eligibility: Clinical ASCVD not at very high risk.

Exceptions: Optional tighter goal depends on clinician judgment and patient preference.

COR 2a · LOE B-R · e1208 · Figure 12

Source guideline

Source mapped; independent clinical review pending.

§4.2.6 · R4Very-high-risk ASCVD targets ≥50% LDL reduction and LDL/non-HDL below 55/85 mg/dL.

Eligibility: ≥2 distinct major events OR 1 major event and ≥2 high-risk conditions.

Exceptions: Do not count the same ACS/MI twice. High-risk age criterion is >65, not ≥65.

COR 1 · LOE A · e1208–09 · Figure 10–11

Source guideline

Source mapped; independent clinical review pending.

§4.2.6 · R5Discuss adding ezetimibe and/or a PCSK9 monoclonal antibody on maximally tolerated statin to meet goals.

Eligibility: Very-high-risk ASCVD on maximally tolerated statin.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE A · e1208 · Figure 11

Source guideline

Source mapped; independent clinical review pending.

§4.2.6 · R6Bempedoic acid is an additional option to reach goals, with or without ezetimibe or PCSK9 mAb.

Eligibility: Very-high-risk ASCVD on maximally tolerated statin.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 2a · LOE B-R · e1208

Source guideline

Source mapped; independent clinical review pending.

§4.2.7 · R1CAC ≥1000; goals below 55/85 mg/dL and ≥50% LDL reduction.

Eligibility: Men ≥40 or women ≥45; no clinical ASCVD.

Exceptions: If untreated baseline already below goal, Figure 13 caveat supports at least 30% LDL reduction. Unknown percentile cannot establish mild-CAC branch.

COR 1 · LOE B-NR · e1213 · Figure 13

Source guideline

Source mapped; independent clinical review pending.

§4.2.7 · R2CAC 300–999; goals below 70/100 mg/dL and ≥50% LDL reduction.

Eligibility: Men ≥40 or women ≥45; no clinical ASCVD.

Exceptions: If untreated baseline already below goal, Figure 13 caveat supports at least 30% LDL reduction. Unknown percentile cannot establish mild-CAC branch.

COR 1 · LOE B-R · e1213 · Figure 13

Source guideline

Source mapped; independent clinical review pending.

§4.2.7 · R3CAC 100–299 or ≥75th standardized percentile; goals below 70/100 mg/dL and ≥50% LDL reduction.

Eligibility: Men ≥40 or women ≥45; no clinical ASCVD.

Exceptions: If untreated baseline already below goal, Figure 13 caveat supports at least 30% LDL reduction. Unknown percentile cannot establish mild-CAC branch.

COR 1 · LOE B-R · e1213 · Figure 13

Source guideline

Source mapped; independent clinical review pending.

§4.2.7 · R4CAC 1–99 and <75th percentile, or incidental mild CAC; consider moderate statin, 30–49% reduction and goals below 100/130 mg/dL.

Eligibility: Men ≥40 or women ≥45; no clinical ASCVD.

Exceptions: If untreated baseline already below goal, Figure 13 caveat supports at least 30% LDL reduction. Unknown percentile cannot establish mild-CAC branch.

COR 2a · LOE B-R · e1213 · Figure 13

Source guideline

Source mapped; independent clinical review pending.

§4.2.7 · R5For CAC 300–999 an optional tighter target is LDL/non-HDL below 55/85 mg/dL.

Eligibility: Men ≥40 or women ≥45; no clinical ASCVD.

Exceptions: If untreated baseline already below goal, Figure 13 caveat supports at least 30% LDL reduction. Unknown percentile cannot establish mild-CAC branch.

COR 2a · LOE B-NR · e1213 · Figure 13

Source guideline

Source mapped; independent clinical review pending.

§4.2.7 · R6Incidental moderate-to-severe CAC supports high-intensity statin and goals below 70/100 mg/dL.

Eligibility: Men ≥40 or women ≥45; no clinical ASCVD.

Exceptions: If untreated baseline already below goal, Figure 13 caveat supports at least 30% LDL reduction. Unknown percentile cannot establish mild-CAC branch.

COR 2a · LOE B-NR · e1213 · Figure 13

Source guideline

Source mapped; independent clinical review pending.

§4.2.3.6 · R2CAC zero may support deferral with repeat CAC in 3–7 years in selected patients who prefer avoiding therapy.

Eligibility: Intermediate or selected borderline risk; men ≥40 or women ≥45.

Exceptions: Not with FH, severe LDL, diabetes age >40, smoking or strong premature family history; never overrides another treatment indication.

COR 2a · LOE B-NR · e1190

Source guideline

Source mapped; independent clinical review pending.

§4.2.9 · R1Persistent elevated TG warrants secondary-cause review and nutrition, activity, weight and alcohol management.

Eligibility: Persistent TG ≥150 mg/dL.

Exceptions: Persistence requires fasting testing, secondary-cause management, 4–12 weeks lifestyle and stable maximally tolerated therapy if indicated.

COR 1 · LOE B-NR · e1227 · Figure 14–17

Source guideline

Source mapped; independent clinical review pending.

§4.2.9 · R6Persistent TG ≥500 despite dietary measures supports discussing fibrates or prescription omega-3 therapy for pancreatitis risk reduction.

Eligibility: Persistent severe TG; particularly ≥1000 mg/dL.

Exceptions: Do not diagnose pancreatitis or substitute nonprescription fish oil. Prompt clinical review of severe values.

COR 2a · LOE B-NR · e1228 · Figure 17

Source guideline

Source mapped; independent clinical review pending.

§4.2.9 · R4Icosapent ethyl may be reasonable for residual ASCVD risk.

Eligibility: Age ≥50; ASCVD or diabetes + ≥1 ASCVD risk; persistent fasting TG 150–499; LDL <100 on maximally tolerated statin.

Exceptions: Not a class-wide outcome claim for omega-3 products.

COR 2b · LOE B-R · e1228 · Figure 15

Source guideline

Source mapped; independent clinical review pending.

§4.2.9 · R7Non-HDL or apoB is preferred over LDL alone for TG-associated decision-making.

Eligibility: TG ≥150 mg/dL.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 2a · LOE B-NR · e1228

Source guideline

Source mapped; independent clinical review pending.

§3.4 · R1Discuss measuring Lp(a) at least once during adulthood.

Eligibility: All adults.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE B-NR · e1168

Source guideline

Source mapped; independent clinical review pending.

§4.2.10 · R1Elevated Lp(a) supports early, optimal management of modifiable cardiovascular risks.

Eligibility: Lp(a) ≥125 nmol/L OR ≥50 mg/dL.

Exceptions: Units are not interconverted; no automatic multiplier of calculated risk.

COR 1 · LOE B-NR · e1234

Source guideline

Source mapped; independent clinical review pending.

§4.2.10 · R2Consider a PCSK9 monoclonal antibody with proven cardiovascular benefit when goals remain unmet.

Eligibility: ASCVD plus elevated Lp(a), unmet LDL/non-HDL goals on maximally tolerated statin.

Exceptions: Not a claim of an approved Lp(a)-specific treatment indication.

COR 1 · LOE B-R · e1234

Source guideline

Source mapped; independent clinical review pending.

§3.3 · R1–2ApoB can clarify particle-related risk, including residual risk despite reaching LDL/non-HDL goals.

Eligibility: Particularly ASCVD, diabetes, CKM syndrome or elevated TG on therapy; optional assessment off therapy.

Exceptions: No automatically assigned apoB goal.

COR 2a / 2b · LOE B-NR · e1167

Source guideline

Source mapped; independent clinical review pending.

§4.2.8.8 · R1Moderate statin alone or combined with ezetimibe is supported for CKD primary prevention.

Eligibility: Age 40–75; established CKD stage ≥3; LDL 70–189.

Exceptions: A single low eGFR does not diagnose chronic kidney disease. Dialysis decisions deferred.

COR 1 · LOE B-R · e1223

Source guideline

Source mapped; independent clinical review pending.

§4.2.8.8 · R2ASCVD with CKD stage ≥3 supports ≥50% LDL reduction and goals below 55/85 mg/dL.

Eligibility: Established CKD stage ≥3 and clinical ASCVD.

Exceptions: Dialysis decisions require individual review.

COR 1 · LOE B-R · e1223

Source guideline

Source mapped; independent clinical review pending.

§4.2.8.9 · R1Discuss statin therapy for prevention and check antiretroviral interactions.

Eligibility: Age 40–75 on stable combination antiretroviral therapy.

Exceptions: Individual benefit-risk discussion and contraindication review required.

COR 1 · LOE B-R · e1224–25

Source guideline

Source mapped; independent clinical review pending.

§4.2.11 · R1Evaluate timing, secondary causes and strength; severe myalgia or weakness supports CK measurement.

Eligibility: Reported statin-associated muscle symptoms.

Exceptions: Symptoms alone do not diagnose statin intolerance. Medication changes deferred pending assessment.

COR 1 · LOE C-LD · e1235 · Figure 18

Source guideline

Source mapped; independent clinical review pending.

§4.2.11 · R2Discuss concerns, cardiovascular risk of discontinuation, and alternative treatment strategies.

Eligibility: Reported muscle symptoms.

Exceptions: No automatic stopping, restarting or dosing instruction.

COR 1 · LOE B-R · e1235

Source guideline

Source mapped; independent clinical review pending.

§3.5 · R1Reassess lipid response 4–12 weeks after starting or changing therapy and every 6–12 months thereafter.

Eligibility: Adults initiating or modifying lipid-lowering therapy.

Exceptions: Individualize timing to clinical circumstances.

COR 1 · LOE A · e1169–70

Source guideline

Source mapped; independent clinical review pending.

§4.2.8 · RScope guardAdditional individualized clinical evaluation is required for pathways outside this release.

Eligibility: Children, older adults with complex care, pregnancy/planning/lactation, dialysis, HoFH, cancer treatment.

Exceptions: This is an application limitation, not a guideline prohibition.

Application scope guard; no treatment evidence grade assigned · e1216–26

Source guideline

Source mapped; independent clinical review pending.