PITTSBURGH — More than half of U.S. adults ages 30 to 79—about 87.5 million people—are now recommended for statins to prevent cardiovascular disease under newly updated clinical guidelines, according to a study by University of Pittsburgh School of Medicine researchers published today in JAMA.
The new recommendations significantly change how doctors assess cardiovascular risk by looking beyond the next 10 years to a person’s risk over several decades. Even though newer calculators often estimate lower short-term risk than older tools, the guidelines broaden statin eligibility. As a result, an additional 21.5 million Americans are now recommended for statins, bringing the total to 56.6% of adults ages 30 to 79.
In March 2026, the American Heart Association, the American College of Cardiology and others released updated guidelines for managing high cholesterol to help prevent cardiovascular events, including heart attacks and strokes. The recommendations incorporated an updated risk calculator released in 2023 and broadened eligibility by expanding the age range from 40–75 to 30–79 and extending the risk horizon from 10 years to 30 years.
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“The shift to a longer view of cardiovascular disease risk is a sea change for doctors in counseling patients,” said Timothy S. Anderson, M.D., M.A.S., a primary care physician, health quality researcher and assistant professor of medicine at Pitt. “We wanted to better understand the potential population-health effect of this shift.”
“Before the new guidelines, people who were flagged with high cholesterol in their 30s and 40s tended to be recommended to focus on diet and exercise and were not recommended medication—unless the patient already had heart disease or other factors that made them particularly high-risk, like diabetes.”
The team analyzed data from 4,366 participants in the National Health and Nutrition Examination Survey, representing about 154.5 million U.S. adults who do not have existing cardiovascular disease, from 2017 to 2023. The analysis focused specifically on primary prevention—reducing risk before a heart attack or stroke occurs—and did not include pregnant individuals in the study sample.
The results showed that age remains a strong predictor of risk. Relatively few—just 11.1%—of adults in their 30s are recommended statins. Eligibility increases steadily over time, with 85% of people in their 60s and most individuals in their 70s—93.5%—qualifying under the new guidelines.
The vast expansion of people recommended for treatment is heavily driven by patients who are generally considered to be at low risk in the shorter term, meaning they are under 3% risk of having a heart attack or stroke within 10 years, but modest risk—over 10%—within 30 years.
Anderson, who was a member of the committee that wrote the new guidelines, acknowledges that they represent a major conceptual shift for patients, too, as they face the question of whether to start a daily medication now to prevent something from happening more than 10 years down the road.
“Many of my younger patients wonder why they can’t put off starting treatment—which is understandable, given they might have low risk of a cardiovascular event 10 years out—and some likely can with a strong focus on healthy diet, exercise and weight. But for patients seeking to fully minimize risks of heart attacks and strokes, early statin therapy may be a good choice.”
Anderson adds that the biology of cardiovascular disease is an evolving story.
“Observational evidence suggests the longer people are exposed to high levels of inflammatory cholesterol molecules, the greater their downstream risks of heart attacks and strokes are. Unfortunately, we do not have randomized clinical trials for low-risk people 30 years out that would directly support this new understanding of how risk builds more gradually over the years—because such trials are expensive, and we need to wait decades for the answer,” he said.
“Ultimately, in this grey zone, patients should talk to doctors. This is a preference-based decision that should take into account the potential for modest cardiovascular risk reduction alongside the potential for adverse drug events, costs and patient preferences.”
Importantly, Anderson stresses, medication is not the only tool in the toolkit for cardiovascular disease prevention. “It's certainly very reasonable that many people will talk about this with their doctor and say, ‘Okay, what can I do that does not involve medication?’” Physicians have long recommended lifestyle changes like healthy diet, exercise and smoking cessation to all their patients, regardless of whether they have high cholesterol—and will continue to do so.
Additional authors on the study include Linnea M. Wilson, M.P.H., of Beth Israel Deaconess Medical Center and the University of Colorado, and Jeremy B. Sussman, M.D., of the University of Michigan.
This research was supported by the National Institute on Aging (K76AG074878).
