For the first time in eight years, the LDL cholesterol targets just changed. Preventive cardiologist Seth Baum, who chairs the Family Heart Foundation, walks through the March 2026 ACC and AHA guideline update: the new LDL thresholds by risk level, a new risk calculator, universal lipoprotein(a) screening, an elevated role for coronary calcium scoring, and what the changes mean for clinicians and patients navigating cholesterol going forward.

⏱️ Chapters:
0:00 Introduction
2:32 Why the 2013 guidelines were a mistake
6:36 The new LDL targets: under 55, 70, or 100
7:48 Why cardiovascular deaths are climbing again
12:57 The actual numbers on statin side effects
14:30 What to use when statins are not an option
17:05 Stop calling it the LDL hypothesis
19:06 What the new PREVENT risk calculator changes
23:51 Lipoprotein(a): the triple threat most clinicians miss
27:41 Why ApoB catches risk that LDL misses
32:18 What a coronary calcium score over 300 now means
37:22 What is coming next for LDL and Lp(a)
39:54 How to talk to statin-hesitant patients
42:49 Take home messages

About this episode:
Seth Baum, a Columbia-trained preventive cardiologist, founder of Flourish Research, chairman of the Family Heart Foundation, and past president of the American Society for Preventive Cardiology, joins Kevin Pho to explain what the March 2026 ACC and AHA cholesterol guideline update actually changed. Baum walks through why the 2013 guidelines shifted away from LDL targets and why the 2026 update brings them back, with specific thresholds by risk category (under 55 for the highest risk, under 70 for high risk, under 100 for others). He explains the new PREVENT risk calculator and the debate over how accurately it identifies higher-risk patients, how universal lipoprotein(a) screening is now recommended for the first time and why that matters for about 20 percent of the population, and how a coronary calcium score over 300 now elevates a patient into the highest-risk treatment category. He also covers apolipoprotein B as a more accurate risk marker than LDL alone, the current non-statin options (PCSK9 inhibitors, ezetimibe, inclisiran, bempedoic acid), what to watch for in upcoming Lp(a) therapies, and practical language for talking with statin-hesitant patients using basic physiology rather than argument.

This episode is sponsored by Novartis Pharmaceuticals Corporation. Dr. Baum was not compensated for his participation in today's episode. The opinions expressed are his alone and do not represent the opinions of Novartis Pharmaceuticals Corporation. The opinions expressed are those of the healthcare provider and do not represent those of Novartis.

🤝 Partner with me on the KevinMD platform:
With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Let's work together to tell your story.

➡️ VISIT SPONSOR: https://Novartis.us/cardiovascular-disease
➡️ PARTNER WITH KEVINMD: https://kevinmd.com/influencer
➡️ SUBSCRIBE TO THE PODCAST: https://www.kevinmd.com/podcast
➡️ RECOMMENDED BY KEVINMD: https://www.kevinmd.com/recommended

#Cardiology #PreventiveCardiology #Cholesterol