Interpretation of the 2026 ACC/AHA guideline on the management of dyslipidemia and the implications for cardiovascular surgery practice_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Tengyue , CUI Hongzhan , LIU Yu , BU Jiqiang , SUN Yongquan , CHEN Ziying ,  MA Qianli

Department of Cardiovascular Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, P. R. China;

Corresponding?author：

MA Qianli, Email: 27200452@hebmu.edu.cn

Keywords：

Dyslipidemia; atherosclerotic cardiovascular disease; risk assessment; secondary prevention; coronary artery bypass grafting; guideline interpretation; cardiovascular surgery

DOI：

10.7507/1007-4848.202604038

Video：

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In March 2026, the American College of Cardiology (ACC), the American Heart Association (AHA) and other professional societies released the "Guideline on the Management of Dyslipidemia". Building on the 2018 "Guideline on the Management of Blood Cholesterol", the new guideline incorporates recent evidence from large-scale randomized cardiovascular outcome trials and contemporary risk-prediction studies. It broadens the focus of lipid management from cholesterol-centered treatment to a comprehensive, life-course management of atherogenic lipoprotein risk. For patients undergoing cardiovascular surgery, the guideline is pertinent not only for perioperative risk stratification and postoperative secondary prevention, but also offers a more sophisticated framework for long-term comprehensive management. In this article, combined with clinical guidelines and key evidence-based evidence, we interpret the major updates of the 2026 edition of the guideline and implications for cardiovascular surgical practice, with the aim of providing a reference for perioperative and long-term blood lipid management for cardiovascular surgery patients.

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4.	Khan SS, Beidas RS. Translating the 2026 dyslipidemia guideline for impact: the science needed for implementing the prevent equations[J]. J Am Coll Cardiol, 2026, 87(19): 2594-2596.
5.	Anderson TS, Wilson LM, Sussman JB. Atherosclerotic cardiovascular disease risk estimates using the predicting risk of cardiovascular disease events equations[J]. JAMA Intern Med, 2024, 184(8): 963-970.
6.	Budoff MJ, Young R, Burke G, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA)[J]. Eur Heart J, 2018, 39(25): 2401-2408.
7.	Khan SS, Post WS, Guo X, et al. Coronary artery calcium score and polygenic risk score for the prediction of coronary heart disease events[J]. JAMA, 2023, 329(20): 1768-1777.
8.	Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHP/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart ASsociation Task Force on Clinical Practice Guidelines[J]. Circulation, 2019, 139(25): e1082-e1143.
9.	陳夢, 張恒, 黃志海, 等. 入院低密度脂蛋白膽固醇和非高密度脂蛋白膽固醇水平對糖尿病患者冠狀動脈旁路移植術后院內不良結局的影響[J]. 中國循環雜志, 2026, 41(4): 368-374.Chen M, Zhang H, Huang ZH, et al. Impact of low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol levels at admission on in-hospital adverse outcomes after coronary artery bypass grafting in diabetic patients[J]. Chin Circ J, 2026, 41(4): 368-374.
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11.	Yu Q, Xue Q, Liu H, et al. Impact of low-density lipoprotein cholesterol and lipoprotein(a) on mid-term clinical outcomes following coronary artery bypass grafting: a secondary analysis of the DACAB trial[J]. Front Cardiovasc Med, 2023, 10: 1103681.
12.	Verma S, Leiter LA, Teoh H, et al. Effect of evolocumab on saphenous vein graft patency after coronary artery bypass surgery (NEWTON-CABG CardioLink-5): an international, randomised, double-blind, placebo-controlled trial[J]. Lancet, 2025, 406(10509): 1223-1234.
13.	Szarek M, Leiter LA, Teoh H, et al. Relationship between achieved LDL-C and saphenous vein graft patency: a post hoc analysis of the NEWTON-CABG CardioLink-5 study[J]. Eur J Prev Cardiol, 2026, 33: zwag190.
14.	Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement[J]. Eur Heart J, 2022, 43(39): 3925-3946.
15.	Chapman MJ, Therond P, Meikle PJ. Bioactive lipids in plasma and atherogenic apoB-containing lipoproteins: effects of statins and PCSK9 inhibitors and relevance to residual cardiovascular risk[J]. Pharmacol Ther, 2026, 284: 109050.
16.	Ray KK, Troquay RPT, Visseren FLJ, et al. Long-term efficacy and safety of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol (ORION-3): results from the 4-year open-label extension of the ORION-1 trial[J]. Lancet Diabetes Endocrinol, 2023, 11(2): 109-119.
17.	范例, 韓志華, 張阿蓮, 等. 英克司蘭在ASCVD不同風險人群血脂管理中的臨床應用分析[J]. 中國新藥雜志, 2026, 35(1): 64-71.Fan L, Han ZH, Zhang AL, et al. Clinical analysis of inclisiran in lipid management among different risk populations with atherosclerotic cardiovascular disease[J]. Chin J New Drugs, 2026, 35(1): 64-71.
18.	Nissen SE, Lincoff AM, Brennan D, et al. Bempedoic acid and cardiovascular outcomes in statin-intolerant patients[J]. N Engl J Med, 2023, 388(15): 1353-1364.
19.	王增武, 劉靜, 李建軍, 等. 中國血脂管理指南 (2023年)[J]. 中國循環雜志, 2023, 38(3): 237-271.Wang ZW, Liu J, Li JJ, et al. Chinese guidelines for lipid management (2023)[J]. Chin Circ J, 2023, 38(3): 237-271.
20.	Li J, Zhao X, Xu J, et al. Utility of the China-PAR score in predicting secondary events among patients undergoing percutaneous coronary intervention[J]. Chin Med J (Engl), 2025, 138(5): 598-600.

1. Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APHP/ASPC/NLA/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2026, 153(17): e1154-e1276.
2. Nordestgaard BG, Langsted A. Lipoprotein(a) and cardiovascular disease[J]. Lancet, 2024, 404(10459): 1255-1264.
3. Khan SS, Matsushita K, Sang Y, et al. Development and validation of the american heart association's prevent equations[J]. Circulation, 2024, 149(6): 430-449.
4. Khan SS, Beidas RS. Translating the 2026 dyslipidemia guideline for impact: the science needed for implementing the prevent equations[J]. J Am Coll Cardiol, 2026, 87(19): 2594-2596.
5. Anderson TS, Wilson LM, Sussman JB. Atherosclerotic cardiovascular disease risk estimates using the predicting risk of cardiovascular disease events equations[J]. JAMA Intern Med, 2024, 184(8): 963-970.
6. Budoff MJ, Young R, Burke G, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA)[J]. Eur Heart J, 2018, 39(25): 2401-2408.
7. Khan SS, Post WS, Guo X, et al. Coronary artery calcium score and polygenic risk score for the prediction of coronary heart disease events[J]. JAMA, 2023, 329(20): 1768-1777.
8. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHP/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart ASsociation Task Force on Clinical Practice Guidelines[J]. Circulation, 2019, 139(25): e1082-e1143.
9. 陳夢, 張恒, 黃志海, 等. 入院低密度脂蛋白膽固醇和非高密度脂蛋白膽固醇水平對糖尿病患者冠狀動脈旁路移植術后院內不良結局的影響[J]. 中國循環雜志, 2026, 41(4): 368-374.Chen M, Zhang H, Huang ZH, et al. Impact of low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol levels at admission on in-hospital adverse outcomes after coronary artery bypass grafting in diabetic patients[J]. Chin Circ J, 2026, 41(4): 368-374.
10. Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts[J]. N Engl J Med, 1997, 336(3): 153-162.
11. Yu Q, Xue Q, Liu H, et al. Impact of low-density lipoprotein cholesterol and lipoprotein(a) on mid-term clinical outcomes following coronary artery bypass grafting: a secondary analysis of the DACAB trial[J]. Front Cardiovasc Med, 2023, 10: 1103681.
12. Verma S, Leiter LA, Teoh H, et al. Effect of evolocumab on saphenous vein graft patency after coronary artery bypass surgery (NEWTON-CABG CardioLink-5): an international, randomised, double-blind, placebo-controlled trial[J]. Lancet, 2025, 406(10509): 1223-1234.
13. Szarek M, Leiter LA, Teoh H, et al. Relationship between achieved LDL-C and saphenous vein graft patency: a post hoc analysis of the NEWTON-CABG CardioLink-5 study[J]. Eur J Prev Cardiol, 2026, 33: zwag190.
14. Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement[J]. Eur Heart J, 2022, 43(39): 3925-3946.
15. Chapman MJ, Therond P, Meikle PJ. Bioactive lipids in plasma and atherogenic apoB-containing lipoproteins: effects of statins and PCSK9 inhibitors and relevance to residual cardiovascular risk[J]. Pharmacol Ther, 2026, 284: 109050.
16. Ray KK, Troquay RPT, Visseren FLJ, et al. Long-term efficacy and safety of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol (ORION-3): results from the 4-year open-label extension of the ORION-1 trial[J]. Lancet Diabetes Endocrinol, 2023, 11(2): 109-119.
17. 范例, 韓志華, 張阿蓮, 等. 英克司蘭在ASCVD不同風險人群血脂管理中的臨床應用分析[J]. 中國新藥雜志, 2026, 35(1): 64-71.Fan L, Han ZH, Zhang AL, et al. Clinical analysis of inclisiran in lipid management among different risk populations with atherosclerotic cardiovascular disease[J]. Chin J New Drugs, 2026, 35(1): 64-71.
18. Nissen SE, Lincoff AM, Brennan D, et al. Bempedoic acid and cardiovascular outcomes in statin-intolerant patients[J]. N Engl J Med, 2023, 388(15): 1353-1364.
19. 王增武, 劉靜, 李建軍, 等. 中國血脂管理指南 (2023年)[J]. 中國循環雜志, 2023, 38(3): 237-271.Wang ZW, Liu J, Li JJ, et al. Chinese guidelines for lipid management (2023)[J]. Chin Circ J, 2023, 38(3): 237-271.
20. Li J, Zhao X, Xu J, et al. Utility of the China-PAR score in predicting secondary events among patients undergoing percutaneous coronary intervention[J]. Chin Med J (Engl), 2025, 138(5): 598-600.

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Latest ArticlesInterpretation of the 2026 ACC/AHA guideline on the management of dyslipidemia and the implications for cardiovascular surgery practice

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