(CNN) — An estimated 21.5 million additional adults in the United States may now be eligible for statins under updated cholesterol treatment guidelines, according to a new study.
The researchers aimed to estimate how many adults in the US would be considered eligible for statin therapy under the new 2026 blood cholesterol guidelines issued by the American Heart Association, the American College of Cardiology and nine partnering medical societies, compared with the previous 2018 guidelines.
The analysis, published July 20 in the journal JAMA, found that the changes could bring the total number of Americans eligible for statins, medications that lower cholesterol, to about 87.5 million people, or more than half of adults ages 30 to 79.
What prompted this major expansion, and does being eligible mean that someone should immediately begin taking medication? To help us understand the study and what patients should discuss with their healthcare providers, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner.
CNN: Who are the millions of Americans who are newly eligible for statins and why?
Dr. Leana Wen: The team analyzed data from more than 4,300 participants in a national health survey collected between 2017 and 2023. The sample was designed to represent about 154 million American adults ages 30 to 79 who did not already have known cardiovascular disease.
The researchers applied both the old and new guidelines to the same population. More than 21 million adults who were not previously recommended statins would become eligible under the new guidance, the study authors found. Altogether, an estimated 87.5 million adults, or nearly 57% of the population studied, would be eligible for statin therapy for what’s called primary prevention, which aims to prevent a first heart attack, stroke or other cardiovascular event.
CNN: Why do the updated guidelines make so many more people eligible for statin therapy?
Wen: There are four major changes that significantly expanded eligibility. First, the age range for cardiovascular risk assessment increased. The earlier guidelines focused primarily on adults ages 40 to 75. The new recommendations apply risk estimation to adults ages 30 to 79.
Second, the guideline lowered the thresholds used to categorize cardiovascular risk. Under the new recommendations, someone is considered at high risk with a 10% chance of having a cardiovascular event over the next 10 years, intermediate risk at 5% and borderline risk at 3%.
Third, the guidelines now give greater weight to certain medical conditions. For instance, adults ages 40 to 75 with more advanced chronic kidney disease or with HIV may qualify for statins.
Finally, the updated guidelines place greater emphasis on long-term cardiovascular risk. For instance, someone with less than a 3% chance of developing cardiovascular disease over the next 10 years may still be considered for a statin if their estimated 30-year risk is at least 10%.
CNN: Many of the newly eligible adults have low estimated risk over the next 10 years. Why might treatment be recommended?
Wen: Cardiovascular disease develops gradually because LDL or low-density lipoprotein, often called “bad” cholesterol, can build up inside artery walls over decades and form plaques that increase the risk of heart attack and stroke. A 40-year-old could have a low chance of a cardiovascular disease during the next decade largely because of their younger age, but this does not necessarily translate to their overall lifetime risk being low. If they have persistently elevated LDL, high blood pressure, diabetes, smoking exposure or a strong family history, their risk may rise substantially over future decades.
The new guidelines therefore incorporate 30-year risk estimates for adults ages 30 to 59. The goal is to identify people who may benefit from reducing cholesterol earlier rather than waiting until their 10-year risk becomes high.
CNN: Does being eligible under the guidelines mean that someone should definitely start taking a statin?
Wen: No. Eligibility means that statin therapy should be considered, not that every person must take it.
Individuals at high risk should consider starting statin treatment — for instance, those with very high LDL, diabetes, advanced chronic kidney disease or high estimated cardiovascular risk. For others, the decision should be individualized and based on factors including age, smoking status, family history, medical conditions and tolerance for taking a daily medication.
A younger adult with a low chance of having a heart attack in the next decade may reasonably make a different decision than an older adult with the same LDL level but much higher near-term risk.
CNN: How should people find out whether they are among those who are newly eligible?
Wen: The first step is to know your numbers. That includes a recent lipid panel, which measures your total cholesterol, LDL (“bad”) cholesterol, high-density lipoprotein or HDL (“good”) cholesterol, and triglycerides, as well as other factors in your medical history such as whether you have diabetes, high blood pressure, or other medical conditions such as kidney disease and HIV. Clinicians can enter this information into the American Heart Association’s PREVENT calculator, which estimates the chance of developing cardiovascular disease over 10 years and, for many younger adults, over 30 years.
Your healthcare provider may also recommend other tests. One is a coronary artery calcium scan, a specialized CT scan that looks for calcified plaque in the arteries supplying the heart. This test can be especially useful for people in borderline or intermediate risk groups who are unsure about beginning medication. A higher calcium score suggests that plaque is already present and can strengthen the case for treatment. A score of zero may support delaying or avoiding a statin in some patients, though that decision still depends on age and other risk factors.
Additional blood tests, including measuring levels of lipoprotein(a) and apolipoprotein B, can also refine risk. These tests are not necessary for everyone; they are most useful when the decision remains unclear after reviewing standard risk factors.
CNN: What should patients ask their healthcare providers before deciding whether to begin treatment?
Wen: I would begin by asking what specific feature of your health makes you eligible for treatment. The answers clarify whether the recommendation is driven by the LDL numbers, calculated risk, other medical conditions or some combination.
Patients should also ask about the expected benefit. A useful way to frame this is not “will a statin lower my cholesterol?” but “what is my risk of heart attack or stroke over the next 10 or 30 years, and how much is it likely to reduce that risk?”
In addition, ask how treatment will be monitored. That may include repeating tests to assess cholesterol levels after medication begins, reviewing symptoms and adjusting the dose if needed.
CNN: What are the benefits and potential side effects of statins, particularly for people who may take them for decades?
Wen: Statins are among the most extensively studied medications in medicine. Most people tolerate them well. The most commonly discussed adverse effect is muscle pain or weakness. Some people who develop symptoms on one statin can tolerate another drug, a lower dose or a different dosing schedule.
Statins can also modestly increase blood sugar and the likelihood of developing diabetes, especially in people who already have risk factors for diabetes. However, for someone at substantial cardiovascular risk, the reduction in heart attacks and strokes generally outweighs this small increase in diabetes risk.
The more nuanced question involves younger, lower-risk people who may take medication for decades. Their likelihood of avoiding a heart attack or stroke over the next several years is smaller than it is for someone at higher risk, so potential adverse effects and the burden of long-term treatment weigh more heavily in the decision.
CNN: Where do lifestyle changes fit into these recommendations?
Wen: This is an important point. Lifestyle measures remain essential for everyone. A heart-healthy eating pattern emphasizes vegetables, fruits, whole grains, legumes, nuts, fish and other minimally processed foods. Regular physical activity, maintaining a healthy weight, controlling blood pressure and managing diabetes also reduce cardiovascular risk, as does stopping smoking and limiting excess alcohol.
For some people with a moderate recommendation for statins, it may be reasonable to focus first on lifestyle changes and then reassess cholesterol levels and overall risk. For others, especially those with very high LDL or multiple major risk factors, lifestyle changes should accompany medication.
The central message of the new guidelines is that cholesterol management should begin earlier and be tailored more closely to both a person’s short- and long-term risk. This is not to say that half of American adults should automatically leave their next appointment with a prescription; rather, it’s a call for more people to have conversations with their primary care clinicians about what kinds of measures can help prevent cardiovascular disease years before it could occur.
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