New Cholesterol Guidelines (2026) - Part 1: Recommendations for Testing Cholesterol

New cholesterol guidelines just came out from the American College of Cardiology and American Heart Association (ACC/AHA). I plan on creating a series of posts concerning the content of these guidelines since I manage patient cholesterol levels numerous times on a daily basis. This particular post will be useful to patients who seek to understand cholesterol testing.

First, some basics. When a doctor checks your cholesterol, what they are actually checking is called a "lipid panel" or "lipid profile." Lipid is another name for fat, and cholesterol is a form of fat-soluble lipid. A standard lipid panel will contain the Total Cholesterol (TC), High-Density Lipoprotein Cholesterol (HDL-C), Low-Density Lipoprotein Cholesterol (LDL-C), triglycerides (TG), and non-HDL-C. Non-HDL-C is just the TC minus the HDL-C. Each of these values on the standard lipid panel has different implications for cardiovascular risk and implication for different types of treatment.

The first thing I learned from reading these guidelines is that it's ok, most of the time, to perform the lipid panel when you are in a fasting state. I already knew that triglycerides could be affected by a non-fasting state, but the guidelines reinforced my belief that unless we are really needing to know how high the triglycerides are (most of the time, we do not), non-fasting is ok. This means increased convenience for patients because they won't have to come back on a different day to get their labs drawn just because they are non-fasting. If we really need to check triglycerides, such as if your non-fasting triglycerides are over 400 mg/dL, then the next time we check, we can be sure to have you as the patient fast prior to the blood draw.

The second thing I learned is concerning testing that I have historically not ordered in addition to the standard lipid panel. These guidelines recommend that lipoprotein A, abbreviated Lp(a), should be tested at least once in a patient's life because this lipid test is genetically determined and make confer risks not evident in the standard lipid panel. Another test that could be tested to further optimize cholesterol therapy is called apolipoprotein B (apoB). The apoB test may be useful if patient's "bad" LDL-C cholesterol is already optimized, but we still would like to know if the patient has elevated cardiovascular risk.

Finally, I found it useful to know that these guidelines recommend we recheck the lipid panel 4 to 12 weeks any instance where we add or adjust cholesterol medication. Once the cholesterol levels no longer need adjusting with medication, the levels should be checked once yearly for someone already on cholesterol medication. For those who have a normal cholesterol or who do not need cholesterol medication after checking the lipid panel, the lipid panel should be checked at least every 5 years.

Much more to come concerning these guidelines in the coming weeks!