By Dustin D. Carlson, MSN, MBA, FNP-BC | DDCHealth

If you’ve ever been told that your cholesterol is “a little high,” you may have wondered what that actually means — and what number you should be aiming for.

In 2026, updated cholesterol guidelines brought back something patients and clinicians have been asking for: clear cholesterol treatment goals.

The new recommendations emphasize an important principle: your ideal cholesterol level depends on your individual risk for heart attack and stroke. For people at higher cardiovascular risk, the recommended cholesterol targets are lower.

Here is what you should know.

What Is Cholesterol?

Cholesterol is a waxy substance your body needs to make hormones, vitamin D and cell membranes. The problem isn’t cholesterol itself — it’s having too many cholesterol-containing particles circulating in the bloodstream.

Over time, these particles can enter artery walls and contribute to plaque formation, a process called atherosclerosis.

A standard lipid panel typically includes LDL cholesterol, HDL cholesterol, triglycerides, total cholesterol, and non-HDL cholesterol. LDL is often called “bad cholesterol” because higher levels generally increase cardiovascular risk. HDL helps transport cholesterol away from tissues. Triglycerides are another type of fat circulating in your blood, and non-HDL cholesterol captures cholesterol carried by several potentially harmful particles.

What Should My LDL Cholesterol Be in 2026?

One of the biggest changes in the 2026 cholesterol guidelines is the return of specific LDL cholesterol goals. Your target depends on your cardiovascular risk.

Borderline or Intermediate Cardiovascular Risk

For many adults without known cardiovascular disease who have borderline or intermediate risk, the LDL-C goal is less than 100 mg/dL and the non-HDL-C goal is less than 130 mg/dL. Your clinician may also recommend a certain percentage reduction from your starting LDL level.

High Cardiovascular Risk

For people at high risk of developing cardiovascular disease, the LDL-C goal is less than 70 mg/dL and the non-HDL-C goal is less than 100 mg/dL. This is considerably lower than what many patients historically considered a “normal” cholesterol level.

Established Cardiovascular Disease

If you have already developed atherosclerotic cardiovascular disease — such as coronary artery disease, peripheral artery disease, or a previous heart attack or ischemic stroke — cholesterol treatment becomes even more important. For people with ASCVD who are not considered very high risk, the LDL-C goal is less than 70 mg/dL. For very high-risk ASCVD, the LDL-C goal is less than 55 mg/dL and the non-HDL-C goal is less than 85 mg/dL.

LDL Cholesterol Targets at a Glance

These aren’t one-size-fits-all numbers. Your overall medical history and cardiovascular risk determine which goal is appropriate for you.

How Do We Determine Your Risk?

The 2026 guidelines recommend a newer risk assessment called PREVENT-ASCVD for many adults ages 30–79 who do not already have cardiovascular disease. It estimates the likelihood of developing cardiovascular disease over the next 10 years and can also help assess longer-term risk.

The 2026 categories for 10-year risk are: low risk less than 3%, borderline risk 3% to less than 5%, intermediate risk 5% to less than 10%, and high risk 10% or greater. But a calculator doesn’t tell the whole story. Your clinician may also consider family history, diabetes, kidney disease, smoking, blood pressure, inflammatory conditions and other factors.

What About a Coronary Calcium Score?

Sometimes it’s unclear whether someone would benefit from cholesterol-lowering medication. A coronary artery calcium scan can sometimes help. This quick CT scan looks for calcium within plaque in the coronary arteries. Finding coronary calcium is evidence that atherosclerosis has already begun, even if you have never experienced symptoms.

There’s Another Cholesterol Test You May Need: Lipoprotein(a)

One of the most significant recommendations in the 2026 guidelines involves lipoprotein(a), or Lp(a). Unlike regular LDL cholesterol, Lp(a) is largely determined by genetics. The new guideline recommends that every adult have Lp(a) measured at least once. An Lp(a) level of ≥125 nmol/L, or ≥50 mg/dL, is considered a cardiovascular risk-enhancing factor.

What About ApoB?

Another blood test you may hear about is apolipoprotein B, or ApoB. Each potentially artery-damaging lipoprotein particle generally carries one ApoB molecule. Measuring ApoB therefore gives us an estimate of the number of atherogenic particles circulating in the bloodstream.

When Is Medication Recommended?

Lifestyle changes remain the foundation of cardiovascular prevention, but lifestyle alone isn’t always enough. Statins remain the cornerstone of cholesterol-lowering therapy because they have extensive evidence showing reductions in heart attacks and strokes. Depending on your LDL level, cardiovascular risk and response to treatment, additional medications may sometimes be considered.

What Can I Do to Lower My Cholesterol?

Several lifestyle changes can meaningfully improve cholesterol levels and overall cardiovascular health. Focus on eating more vegetables, fruits, whole grains, legumes, nuts, seeds and other minimally processed foods. Choose healthier unsaturated fats and limit foods high in saturated fat. Regular physical activity, maintaining a healthy weight, avoiding tobacco, getting adequate sleep and controlling blood pressure and diabetes are also important.

High Cholesterol Usually Doesn’t Cause Symptoms

You generally cannot feel high cholesterol. Someone can exercise regularly, feel perfectly healthy and still have significantly elevated LDL cholesterol or Lp(a). That’s why cholesterol screening and cardiovascular risk assessment matter.

Know Your Numbers

If you haven’t had your cholesterol checked recently, or you’ve been told your cholesterol is elevated but aren’t sure what your target should be, it may be time for a more complete cardiovascular risk assessment.

At DDCHealth, we can review your lipid panel, medical and family history, calculate cardiovascular risk, discuss whether additional testing such as Lp(a), ApoB or coronary artery calcium scoring may be appropriate, and develop an individualized prevention and treatment plan.

DDCHealth is accepting new primary care patients. In-office and telehealth appointments are available. Be Well.

This article is intended for general educational purposes and does not replace individualized medical advice. Cholesterol treatment goals and medication decisions should be based on your complete medical history and cardiovascular risk.

Sources

2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. American College of Cardiology and American Heart Association, 2026.