AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Estimated Impact of Expanded Statin Eligibility Under 2026 Lipid Guidelines
By Jhawar R, Bhatt DL
Background: The 2026 ACC/AHA lipid lowering therapy guidelines incorporate AHA PREVENT risk scoring and recommend initiation of statin therapy at lower risk thresholds than the prior 2019 guidelines. Research Questions: 1. How many U.S. adults are newly eligible for statin therapy? 2. What is the potential event reduction if all eligible individuals are treated? Methods: We analyzed NHANES 2021-2023 participants aged 30-59 years, excluding those already on statins, and determined statin eligibility based on both 2019 guidelines and 2026 guidelines. Expected treatment effect was modeled from guideline-specific LDL-C reduction targets using a 22% relative atherosclerotic cardiovascular disease (ASCVD) risk reduction per 1 mmol/L LDL-C reduction based on results from the Cholesterol Treatment Trialists’ Collaboration. Absolute risk reduction (ARR) and ASCVD events avoided were estimated using PREVENT risk and NHANES survey weights. Results: We analyzed 1,356 adults, representing about 109 million Americans. New guidelines identified an additional 11.3% of 30-59 year U.S. adults as eligible, corresponding to about 12 million newly eligible U.S. adults ( Panel A ). If all currently eligible adults were treated, estimated mean ARR would be 0.72% over 10 years (NNT of 139) and 3.54% over 30 years (NNT of 28). This yields 152,649 events avoided over 10 years and 752,796 events avoided over 30 years ( Panel B ). Relative to 2019 criteria, expanded eligibility was associated with an additional 54,583 events avoided over 10 years and 214,973 over 30 years. Still, 437,456 10-year events (24% of total 10-year events) and 2,875,660 30-year events (31% of total 30-year events) would occur amongst patients not currently eligible for a statin. Conclusions: In U.S. adults aged 30-59 years, PREVENT-based contemporary guidelines substantially expand statin eligibility and are projected to prevent a large number of ASCVD events. However, relative decreases in total events are modest, highlighting an ongoing role for additional risk stratification approaches and risk reduction agents.