Millions of Americans may have cholesterol levels that are now considered too high under newly updated heart health guidelines, according to a new study from Mass General Brigham.
The research suggests that many people who could benefit from treatment are either not taking cholesterol-lowering medicine or are not receiving enough treatment to reach the latest goals.
Cholesterol is a fatty substance that the body needs to build cells and make hormones. However, too much low-density lipoprotein (LDL), often called ‘bad’ cholesterol, can build up inside blood vessels.
Over time, this buildup can block blood flow and increase the risk of heart attacks and strokes.
The American College of Cardiology and the American Heart Association released new cholesterol guidelines in 2026.
The updated recommendations set lower LDL targets for many people because growing evidence shows that lower LDL levels provide better protection, especially for people at high risk of heart disease.
To understand how Americans compare with these new targets, researchers analyzed health information from about 2,300 adults aged 30 to 79 who took part in the National Health and Nutrition Examination Survey between 2021 and 2023. These participants represent about 178 million adults across the United States.
The study, published in JAMA, found that nearly one in three adults without previous heart disease had LDL cholesterol levels above the new recommended goals. Among these people, about 76% were not taking any cholesterol-lowering medicine, meaning many had not yet started treatment.
The gap was even greater among people with the highest risk of future heart disease. About 83% had LDL levels above their recommended target, and about half were not taking any cholesterol-lowering medicine.
The findings were also concerning for people who had already experienced a heart attack, stroke, or another cardiovascular event. Nearly four out of five were still above the recommended LDL goal. Most were already taking cholesterol medicine, suggesting they may need stronger treatment or additional medicines rather than simply starting therapy.
The researchers explained that treatment needs differ between these two groups. People who have never had heart disease often need to begin cholesterol-lowering treatment if their risk is high enough. People with existing heart disease may instead need a higher dose, an additional medicine, or one of the newer cholesterol-lowering drugs.
The study also highlights barriers that may prevent people from reaching healthy cholesterol levels. These include limited access to newer medicines, lack of awareness about cholesterol targets, and challenges within healthcare systems.
The researchers said these results provide an important starting point because the data were collected before the new guidelines were introduced. Future studies will show whether doctors and patients are able to close the treatment gap over time.
Overall, the study shows that many adults could further reduce their risk of heart attack and stroke by improving LDL cholesterol control.
The findings are based on a large nationally representative survey, making them highly relevant.
However, the study describes current treatment patterns and cannot prove that following the new guidelines will directly prevent every future heart event, although previous clinical trials strongly support lowering LDL cholesterol.
If you care about heart health, please read studies about top 10 foods for a healthy heart, and how to eat right for heart rhythm disorders.
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Source: Mass General Brigham.
