In this episode, we review key updates from the 2026 ACC-AHA Guidelines on the Management of Dyslipidemia.

Key Concepts

1. The PREVENT ASCVD equation is now recommended to calculate ASCVD risk, with thresholds at 3%, 5%, and 10%. The previous 7.5% threshold for statin treatment is now 5%.
2. In addition to the 10-year ASCVD estimate, clinicians should consider the use of Lp(a), "risk enhancers", and coronary artery calcium (CAC) scans as a "tie breaker" with shared decision-making when the decision to treat is not clear.
3. In addition to LDL goals of < 100, < 70, or < 55 (depending on risk), the new guidelines also suggest non-HDL-C and apoB goals once LDL cholesterol is at goal.
4. Many patients will require non-statin therapies to achieve lipid goals. The recommended non-statin therapies include ezetimibe, PCSK9 mAb, PCSK9-interfering RNA, and bempedoic acid.

References

• Writing Committee Members, Blumenthal RS, Morris PB, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(17):e1154-e1276. doi:10.1161/CIR.0000000000001423
• Wiggins BS, Barac A, Benziger CP, et al. 2026 Dyslipidemia Guideline-at-a-Glance. J Am Coll Cardiol. 2026;87(19):2617-2623. doi:10.1016/j.jacc.2026.02.4872
• Superko H, Garrett B. Small Dense LDL: Scientific Background, Clinical Relevance, and Recent Evidence Still a Risk Even with 'Normal' LDL-C Levels. Biomedicines. 2022;10(4):829. Published 2022 Apr 1. doi:10.3390/biomedicines10040829

In this episode, we discuss the most important annual updates in the American Diabetes Association Guidelines, Standards of Care 2026, particularly focusing on changes in pharmacotherapy recommendations and the supporting evidence.

Key Concepts

1. A few existing agents now have ASCVD risk reduction data in patients with existing ASCVD or high indicators for ASCVD. They are: oral semaglutide and tirzepatide.
2. SGLT2is are still first-line in patients with diabetes and HF including HFpEF, but SC semaglutide and tirzepatide are now recommended for those with symptomatic HFpEF and obesity due to positive outcomes in this population.
3. The GLP-1RA and dual GLP-1/GIP RA are the preferred agents for weight management in patients with T2DM, but use of GLP-1RA can be considered for weight loss in patients with T1DM.
4. The guideline also better defines recommendations for medication-induced hyperglycemia from immune checkpoint inhibitors, PI3Kɑ (phosphoinositidylinositol 3-kinase α) inhibitors, mTOR inhibitors, and steroids.

References

• American Diabetes Association. Standards of care in diabetes—2026. Diabetes Care. 2026;49(suppl 1):S1-S377.
• SOUL study. Darren K. McGuire, Marx N, Mulvagh SL, et al. Oral semaglutide and cardiovascular outcomes in high-risk type 2 diabetes. N Engl J Med. 2025;392(20):2001-2012. doi:10.1056/NEJMoa2501006.
• SURPASS-CVOT. Nicholls SJ, Pavo I, Bhatt DL, et al. Cardiovascular outcomes with tirzepatide versus dulaglutide in type 2 diabetes. N Engl J Med. 2025;393(24):2409-2420. doi:10.1056/NEJMoa2505928.
• SUMMIT. Packer M, Zile MR, Kramer CM, et al. Tirzepatide for heart failure with preserved ejection fraction and obesity. N Engl J Med. 2025;392(5):427-437. doi:10.1056/NEJMoa2410027.
• STEP-HFpEF. Kosiborod MN, Abildstrom SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963.
• STEP-HFpEF DM. Kosiborod MN, Petrie MC, Borlaug BA, et al. Semaglutide in patients with obesity‑related heart failure and type 2 diabetes. N Engl J Med. 2024;390(15):1394‑1407. doi:10.1056/NEJMoa2313917.

In this episode, we review key updates from the 2026 AHA/ASA Guideline for the Early Management of Patients With Acute Ischemic Stroke, including changes to IV thrombolysis, antiplatelet therapy, endovascular treatment, blood pressure goals, and glycemic goals.

Key Concepts

1. Tenecteplase (TNKase) is now equally preferred to alteplase (Activase) by the 2026 AHA/ASA guidelines. Tenecteplase has several advantages related to administration and the risk of medication errors.
2. IV thrombolysis can be given in selected patients up to 9 hours after stroke symptom onset depending on brain imaging findings. Patients with symptom onset less than 4.5 hours are still eligible for IV thrombolysis regardless of brain imaging findings.
3. IV thrombolysis should not be given for mild, non-disabling stroke symptoms. A "non-disabling" stroke means the symptoms do not impair activities of daily living or ability to return to work.
4. The criteria for dual antiplatelet therapy (DAPT) has been updated. DAPT can be given for NIHSS of 4 or 5 (not just 3 or less) and can be started up to 72 hours after stroke onset (not just within 24 hours).

References

• Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. Published online January 26, 2026. doi:10.1161/STR.0000000000000513