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    Cholesterol explained: LDL, HDL, triglycerides and the 2026 guideline

    Cholesterol is a waxy, fat-like substance made by the liver; too much LDL cholesterol builds plaque in arteries and raises the risk of heart attack and stroke.[1][2] In March 2026 a new US guideline brought back LDL targets (below 100, 70 or 55 mg/dL depending on risk) and recommended that every adult have Lp(a) measured once.[3][4]

    Editor reviewedStrict sourcingUpdated ExplainerHealth and medicine, GLP-1 and metabolic medicine

    Cholesterol is one of the most-measured numbers in medicine, and in 2026 the rules for reading it changed.[5] This page explains the basic terms, what the March 2026 US guideline did, and where drugs, Lp(a) and diet fit in. It is the starting point of a short crash course; the other pages are listed under “Course”.

    This page is general information, not medical advice. Talk to a clinician about your own cholesterol results and treatment.

    What cholesterol is

    Cholesterol is a waxy, fat-like substance. Your liver makes it, and your body makes all the blood cholesterol it needs.[1] It travels in the blood inside particles called lipoproteins. Too much of the wrong kind builds up as plaque in artery walls. Plaque narrows the arteries and can block blood flow, causing chest pain (angina) or a heart attack.[6]

    High cholesterol has no symptoms, so a blood test is the only way to know your levels.[7] From 2017 to 2020, 86.4 million US adults had high or borderline-high cholesterol.[8]

    Cholesterol and triglycerides travel in lipoproteins. LDL particles drive plaque formation, while HDL levels are inversely associated with risk.[2] The causal role of LDL rests largely on randomised trials. A Cholesterol Treatment Trialists’ meta-analysis of 26 statin trials found each 1.0 mmol/L (about 39 mg/dL) fall in LDL cut major vascular events by just over a fifth.[9] It found no threshold below which lowering stopped helping.[10] Raising HDL with drugs has not worked in the same way: the CETP inhibitor torcetrapib raised HDL by 72% but increased deaths.[11]

    Apolipoprotein B (apoB) counts atherogenic particles, and the 2026 US guideline says it may be a better risk marker than LDL in some groups, such as people with type 2 diabetes or high triglycerides.[12]

    Reading a lipid panel

    A standard lipid panel reports LDL (“bad”) cholesterol, HDL (“good”) cholesterol, triglycerides (a blood fat used for energy) and total cholesterol.[2]

    MeasureCDC “optimal” level
    Total cholesterolAbout 150 mg/dL[13]
    LDL cholesterolAbout 100 mg/dL[13]
    HDL cholesterolAt least 40 mg/dL (men), 50 mg/dL (women)[13]
    TriglyceridesBelow 150 mg/dL[13]

    The CDC says a total cholesterol above 200 mg/dL may be considered high.[14] Most healthy adults should be tested every 4 to 6 years, and some people more often.[15] You may be asked to fast for 8 to 12 hours before the test.[16] Home tests exist too; see the home cholesterol test buyer’s guide.

    What the 2026 US guideline changed

    On 13 March 2026 the American College of Cardiology, the American Heart Association and nine other groups published a new dyslipidemia guideline that replaces the 2018 cholesterol guideline.[5] The main changes:

    • LDL goals are back. The goals are below 100 mg/dL at borderline or intermediate risk, below 70 mg/dL at high risk, and below 55 mg/dL for very-high-risk people with established disease.[3]
    • New risk calculator. The PREVENT equations replace the older Pooled Cohort Equations for estimating 10- and 30-year risk.[17]
    • Earlier treatment. The guideline recommends considering medication early for young people with familial hypercholesterolemia and for young adults with LDL of 160 mg/dL or more.[18]
    • Lp(a) once for everyone. Every adult should have Lp(a) measured at least once.[4] See pcsk9-inhibitors and the Lp(a) explainer.
    • More tests when useful. These include coronary artery calcium scans for some people at borderline or intermediate risk, and apoB in selected groups.[12]

    In Europe, the ESC and EAS published a focused update of their 2019 dyslipidaemia guidelines in 2025.[19] European and US guidance both recommend testing Lp(a) once in adulthood.[20]

    Lowering cholesterol: lifestyle and medicines

    CDC prevention advice is to limit saturated fat, eat fibre-rich foods such as oatmeal and beans, keep a healthy weight, stay active, avoid smoking and limit alcohol.[21] Lp(a) is the exception: it is mostly inherited, and lifestyle changes have little effect on it.[22]

    statins remain the first-line drug. If they are not enough, the guideline recommends adding ezetimibe, bempedoic acid or a PCSK9 antibody.[23] Newer options arrived in 2026. The FDA approved the first oral PCSK9 inhibitor, enlicitide (Lipfendra), in July.[24] The European Commission approved the CETP inhibitor obicetrapib in September.[25] The CDC reports that only about half of US adults who could benefit from cholesterol medicine take it.[26] The drugs guide compares the options.

    Weight-loss drugs also move lipids. In the ATTAIN-1 trial, orforglipron improved triglycerides and non-HDL cholesterol versus placebo;[27] see the GLP-1 crash course. Diet timing is a separate question, covered in the intermittent fasting explainer.

    LiveHealth & medicine

    Cholesterol and fasting research tracker 2026

    Live tracker of 2026 lipid and fasting news: the new US guideline, oral PCSK9 approval, obicetrapib in the EU, the pelacarsen miss and fasting trials.

    Developing in Health

    Go deeper

    Questions readers ask

    What is the difference between LDL and HDL cholesterol?

    High LDL cholesterol can lead to plaque buildup in the arteries and heart disease or stroke. High HDL cholesterol is linked to a lower risk of heart disease and stroke, which is why HDL is called "good" cholesterol.[2]

    What cholesterol level is considered high?

    The CDC says a total cholesterol above 200 mg/dL may be considered high. It lists optimal levels as about 150 mg/dL total, about 100 mg/dL LDL, HDL of at least 40 (men) or 50 (women) mg/dL, and triglycerides below 150 mg/dL.[14][13]

    What LDL target does the 2026 US guideline set?

    Below 100 mg/dL for people at borderline or intermediate risk, below 70 mg/dL at high risk, and below 55 mg/dL for very-high-risk people with established cardiovascular disease.[3]

    How often should cholesterol be checked?

    The CDC says most healthy adults should be checked every 4 to 6 years, and people with heart disease, diabetes or a family history of high cholesterol more often.[15]

    Do I need to fast before a cholesterol test?

    Sometimes. The CDC says you may need to fast for 8 to 12 hours and should ask your doctor how to prepare.[16]

    Can diet alone lower cholesterol?

    The CDC recommends limiting saturated fat, eating fibre-rich foods, keeping a healthy weight, staying active, not smoking and limiting alcohol. The 2026 guideline starts with lifestyle but recommends medication earlier for people whose risk remains high.[21][17]

    Sources

    · 27 claims from 13 publishers

    Each numbered claim is a statement we checked against the sources listed with it. Tap a number in the text to see its sources in place.

    1. [1]

      The CDC describes blood cholesterol as a waxy, fat-like substance made by the liver, and says the body makes all the blood cholesterol it needs. confirmedas of 2026-10-11

      • About Cholesterol · Centers for Disease Control and Prevention · What it is (retrieved 2026-10-11)
      • About Cholesterol · Centers for Disease Control and Prevention · What it is (retrieved 2026-10-11)
    2. [2]

      A standard cholesterol check (lipid panel) measures LDL cholesterol, which can lead to plaque buildup in arteries; HDL cholesterol, high levels of which are linked to lower heart disease and stroke risk; triglycerides, a blood fat used for energy; and total cholesterol. confirmedas of 2026-10-11

      • About Cholesterol · Centers for Disease Control and Prevention · What do blood cholesterol numbers mean? (retrieved 2026-10-11)
      • About Cholesterol · Centers for Disease Control and Prevention · What do blood cholesterol numbers mean? (retrieved 2026-10-11)
    3. [3]

      The 2026 ACC/AHA guideline brings back LDL cholesterol treatment goals of below 100 mg/dL for people at borderline or intermediate risk, below 70 mg/dL at high risk, and below 55 mg/dL for secondary prevention in people with ASCVD at very high risk. confirmedas of 2026-10-11

    4. [4]

      The 2026 ACC/AHA guideline recommends measuring Lp(a) at least once in adulthood (a Class I recommendation), noting that lifestyle changes minimally affect Lp(a) so repeat testing is generally not needed. confirmedas of 2026-10-11

    5. [5]

      On 13 March 2026 the ACC, AHA and nine other organisations published a new US Guideline on the Management of Dyslipidemia in JACC, covering high blood cholesterol, hypertriglyceridemia and elevated Lp(a); it retires and replaces the 2018 cholesterol guideline. confirmedas of 2026-10-11

    6. [6]

      High blood cholesterol can cause plaque to build up in artery walls, narrowing them and blocking blood flow, which can cause chest pain (angina) or a heart attack. confirmedas of 2026-10-11

      • About Cholesterol · Centers for Disease Control and Prevention · What problems does high cholesterol cause? (retrieved 2026-10-11)
      • About Cholesterol · Centers for Disease Control and Prevention · What problems does high cholesterol cause? (retrieved 2026-10-11)
    7. [7]

      High cholesterol has no symptoms, so the only way to know your levels is a blood test (a lipid profile). confirmedas of 2026-10-11

    8. [8]

      From 2017 to 2020, 86.4 million US adults aged 20 or older had high or borderline-high cholesterol (total cholesterol of 200 mg/dL or more), according to the CDC. confirmedas of 2026-10-11

    9. [9]

      A Cholesterol Treatment Trialists' meta-analysis of 26 randomised statin trials (about 170,000 participants) found that each 1.0 mmol/L (about 39 mg/dL) reduction in LDL cholesterol cut the annual rate of major vascular events by just over a fifth (rate ratio 0.78) and all-cause mortality by 10%. confirmedas of 2026-10-11

    10. [10]

      The 2010 CTT meta-analysis found no evidence of a threshold within the cholesterol range studied and no significant effect on cancer incidence, even at low LDL levels. confirmedas of 2026-10-11

    11. [11]

      The earlier CETP inhibitor torcetrapib raised HDL cholesterol by 72.1% but its outcome trial (15,067 patients) was stopped early because it increased cardiovascular events (hazard ratio 1.25) and death from any cause (hazard ratio 1.58). confirmedas of 2026-10-11

    12. [12]

      The 2026 guideline recommends selective coronary artery calcium (CAC) scans for men over 40 and women over 45 at borderline or intermediate risk, and says apolipoprotein B may be a more accurate risk marker than LDL cholesterol in groups such as people with type 2 diabetes or high triglycerides. confirmedas of 2026-10-11

    13. [13]

      The CDC lists optimal levels as total cholesterol of about 150 mg/dL, LDL cholesterol of about 100 mg/dL, HDL cholesterol of at least 40 mg/dL in men and 50 mg/dL in women, and triglycerides below 150 mg/dL. confirmedas of 2026-10-11

      • About Cholesterol · Centers for Disease Control and Prevention · Optimal Cholesterol Levels table (retrieved 2026-10-11)
      • About Cholesterol · Centers for Disease Control and Prevention · Optimal Cholesterol Levels table (retrieved 2026-10-11)
    14. [14]

      According to the CDC, a total cholesterol above 200 mg/dL may be considered high in adults and children, a condition also called hyperlipidemia. confirmedas of 2026-10-11

      • About Cholesterol · Centers for Disease Control and Prevention · What is high cholesterol? (retrieved 2026-10-11)
    15. [15]

      The CDC says most healthy adults should have their cholesterol checked every 4 to 6 years, and people with heart disease, diabetes or a family history of high cholesterol more often. confirmedas of 2026-10-11

    16. [16]

      The CDC says you may need to fast for 8 to 12 hours before a cholesterol test and should ask your doctor how to prepare. confirmedas of 2026-10-11

      • Getting Your Cholesterol Checked · Centers for Disease Control and Prevention · What do I need to know before getting a cholesterol test? (retrieved 2026-10-11)
    17. [17]

      The 2026 guideline recommends the PREVENT-ASCVD equations instead of the older Pooled Cohort Equations for 10- and 30-year risk estimates in adults aged 30 to 79, and says LDL-lowering therapy is reasonable at a borderline 10-year risk of 3% to under 5% and recommended at intermediate risk of 5% to under 10% after a clinician-patient discussion. confirmedas of 2026-10-11

    18. [18]

      The 2026 guideline emphasises earlier intervention, recommending early consideration of medication for young people with familial hypercholesterolemia and young adults with LDL cholesterol of 160 mg/dL or more or a strong family history of premature ASCVD. confirmedas of 2026-10-11

    19. [19]

      The European Society of Cardiology and European Atherosclerosis Society published a 2025 focused update of their 2019 dyslipidaemia guidelines. confirmedas of 2026-10-11

    20. [20]

      The European Atherosclerosis Society's 2022 consensus statement recommends testing Lp(a) at least once in adults, and Novartis states that US and European guidelines both recommend once-in-a-lifetime Lp(a) testing for all adults. confirmedas of 2026-10-11

    21. [21]

      CDC prevention advice includes limiting foods high in saturated fat, eating fibre-rich foods such as oatmeal and beans, keeping a healthy weight (overweight and obesity raise LDL), regular physical activity, not smoking and limiting alcohol, which can raise cholesterol and triglycerides. confirmedas of 2026-10-11

    22. [22]

      Elevated Lp(a) is an inherited risk factor affecting about one in five people worldwide; Lp(a) levels are about 90% genetically determined and largely unaffected by diet or lifestyle, and no targeted Lp(a) treatment was approved as of September 2026. confirmedas of 2026-10-11

    23. [23]

      If lifestyle and statins do not lower LDL cholesterol enough, the 2026 guideline recommends adding nonstatin therapy such as ezetimibe, bempedoic acid or a PCSK9 monoclonal antibody, and notes that inclisiran is still being studied to show whether its LDL lowering reduces cardiac events. confirmedas of 2026-10-11

    24. [24]

      The FDA approved Merck's enlicitide (Lipfendra) 20 mg tablets in July 2026 (FDA action date 15 July; Merck announced it on 16 July) to lower LDL cholesterol in adults with hypercholesterolemia, including heterozygous familial hypercholesterolemia, making it the first FDA-approved oral PCSK9 inhibitor. confirmedas of 2026-10-11

    25. [25]

      On 21 September 2026 NewAmsterdam and Menarini announced that the European Commission had granted marketing authorisation for Ubeslo and Evlarco, the first regulatory approval of obicetrapib worldwide, with a requirement to submit final results of the PREVAIL outcomes trial. confirmedas of 2026-10-11

    26. [26]

      The CDC reports that slightly more than half of US adults (54.5%, or 47 million people) who could benefit from cholesterol medicine are taking it. confirmedas of 2026-10-11

      • High Cholesterol Facts · Centers for Disease Control and Prevention · 2024-10-24 · High total cholesterol in the United States (retrieved 2026-10-11)
    27. [27]

      In the phase 3 ATTAIN-1 trial of 3,127 adults with obesity without diabetes, orforglipron produced mean weight changes of -7.5%, -8.4% and -11.2% at 6, 12 and 36 mg at 72 weeks, versus -2.1% with placebo, with improvements in waist circumference, systolic blood pressure, triglycerides and non-HDL cholesterol. confirmedas of 2025-09-16

    Revision history (1)
    1. Page created.

    Created Oct 11, 2026. Last reviewed by an editor on Oct 11, 2026. Next scheduled review: Jan 11, 2027.

    Cite this page

    "Cholesterol explained: LDL, HDL, triglycerides and the 2026 guideline." ContentLora, updated Oct 11, 2026. https://contentlora.com/explain/cholesterol-explained

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