Preventing and treating high cholesterol is a long-standing challenge for providers and patients alike. High cholesterol has no symptoms, so many patients are unaware of their risk until a routine physical reveals their numbers — and even after diagnosis, many patients remain resistant to recommended medical treatment.

About 86 million adults aged 20 or older — 1 in every 1.2 adults — have high or borderline high cholesterol, defined as a total cholesterol level of 200 mg/dL or higher. An additional 25 million have total cholesterol levels above 240 mg/dL.¹

Patients can be resistant to cholesterol treatment for several reasons, including medication aversion, a preference for lifestyle management such as diet and exercise, and fear of adverse medication reactions or side effects.

New developments and cholesterol guidelines

Future cholesterol treatment is marching toward a merged approach. Earlier screening and new pharmacological developments on the horizon all offer new modalities for lowering cholesterol — a combined approach that leverages aspects of early intervention, lifestyle changes, and more. Studies collectively indicate that cholesterol management is moving beyond traditional statins, combining lifestyle and pharmacological innovations to reduce cardiovascular risk more effectively.

In 2026, the American College of Cardiology and the American Heart Association updated cholesterol management guidelines.² Highlights of the new guidance include:

• Every adult aged 19 and older should get tested for lipoprotein (a), or Lp(a), at least once in their lifetime to help determine heart disease or stroke risk and appropriate prevention or treatment. High Lp(a) levels are 125 nmol/L or 50 mg/dL and above.

• Patients with cardiovascular-kidney-metabolic syndrome, type 2 diabetes, high triglycerides, or known cardiovascular disease who have reached their low-density lipoprotein (LDL) cholesterol and non-high-density lipoprotein cholesterol goals should be tested for apolipoprotein B, which measures the number of circulating cholesterol particles in the bloodstream, to provide a clearer picture of heart disease risk.

• Predicting Risk of Cardiovascular Disease EVENTs (PREVENT), a new risk assessment tool, can be used to estimate the chance of a patient having a heart attack or stroke in the next 10 and 30 years. PREVENT calculates risk level using standard health information gleaned from a patient’s annual physical, including age, blood pressure readings, and cholesterol levels.

• A coronary artery calcium scan can be considered for men aged 40 and older and women aged 45 and older with borderline or medium risk to help determine whether cholesterol-lowering medication, such as a statin, is needed.

Overcoming patient misinformation

Patients often have inaccurate and incomplete information about cholesterol and lipid-lowering medications (LLMs), according to a 2025 study.³ The study evaluated the perception and knowledge about cholesterol and LLMs among individuals who were treatment naïve. The same study found that medical professionals are the first line of defense in patient education regarding cholesterol. Medical staff (71 percent) were the most common source of patient information on the topic, ahead of media (58.4 percent) and medical publications (33.3 percent), making conversations with patients about cholesterol and effective cholesterol management critical.  

Consider the following as you are discussing cholesterol and good health with your patients.

Myth: Eating less cholesterol-rich foods can lower cholesterol levels.

Fact: Diet matters, but dietary cholesterol is only one part of the picture. The liver naturally produces cholesterol, and genetics can strongly influence blood cholesterol levels, so simply avoiding cholesterol-rich foods may have a limited effect for many people. Diet remains important: Saturated and trans fats can raise LDL cholesterol, while replacing them with unsaturated fats can help lower cardiovascular risk. Food intake can also substantially affect triglycerides, another blood fat measured on a lipid panel. High triglycerides, especially when accompanied by high LDL or low high-density lipoprotein (HDL) cholesterol, can increase the risk of heart attack and stroke and may signal an underlying concern, such as insulin resistance, metabolic syndrome, or uncontrolled type 2 diabetes.

Myth: High cholesterol only affects overweight individuals.

Fact: Slender people are not immune. Genetics strongly influence cholesterol levels. People of any size can have high cholesterol, particularly if there is a family history. However, weight, diet, physical inactivity, diabetes, and other conditions also contribute. Carrying extra weight, particularly around the abdomen, can increase LDL and triglyceride levels and impede the removal of cholesterol from the bloodstream.

Myth: High HDL can offset or overcome high LDL.

Fact: High HDL does not make patients bulletproof. Healthy HDL levels (60 mg/dL or higher) do provide protective benefits for the heart against the damaging effects of high cholesterol but do not counter the impact of high LDL levels on the heart and arteries.

Myth: High cholesterol only impacts the heart.

Fact: Long-term high cholesterol damages more than the heart. Elevated LDL leads to a buildup of plaque on the walls of arteries. Over time, this buildup causes the narrowing of arteries, which blocks blood flow to and from the heart and other organs. High cholesterol has been linked to stroke, vascular dementia, chronic kidney disease, and peripheral artery disease.

Myth: Statins cause serious side effects, from joint pain to chronic disease.

Fact: Statins are generally safe and effective for most patients and serious side effects are uncommon. Although statins have an unpopular reputation, numerous industry studies have shown that they reduce the risk of heart attack or stroke by lowering cholesterol levels, with few reported side effects such as muscle aches, sleep difficulties, liver or kidney problems, orincreased risk for type 2 diabetes.⁵

A 2025 study identified some of the most common reasons patients may refuse a statin. These reasons include a preference for diet and exercise, the burden of taking multiple medications, family preferences, financial and insurance barriers, disbelief in statin benefits, a preference for alternative therapies like herbal medications or supplements, pregnancy or breastfeeding, social stigma, and general skepticism. The study concluded that addressing existing misinformation on the Internet is a critical challenge to solving statin nonacceptance.⁶

The conclusion: Continued conversations with your patients can make a difference.

Resources

• Cigna Healthcare^® offers coaching support for your patients with high cholesterol and other conditions. Patients can learn more about available resources by calling the number on the back of their ID card or by using the myCigna^® App.⁷
• Coverage information for cholesterol testing is available in our Preventive Care Services (A004) administrative policy.

1. U.S. Centers for Disease Control and Prevention (CDC). “High Cholesterol Facts.” CDC. 24 October 2024. Retrieved from https://www.cdc.gov/cholesterol/data-research/facts-stats/index.html.

2. American Heart Association. “Top 10 Things to Know About the ACC/AHA Cholesterol Guideline.” American Heart Association. 13 March 2026. Retrieved from https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/cholesterol-top-10.

3. Mehmet Kök, et al. “Perceptions and Knowledge of Cholesterol and Lipid-Lowering Medications Among Treatment-Naive Individuals: A Cross-Sectional Study.” Patient Preference and Adherence. 13 May 2025. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC12085121/.

4. Cholesterol Treatment Trialists’ Collaboration. “Assessment of adverse effects attributed to statin therapy in product labels: a meta-analysis of double-blind randomised controlled trials.” The Lancet. 14 February 2026. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01578-8/fulltext.

5. C. Justin Brown, et al. “Assessment of Sex Disparities in Nonacceptance of Statin Therapy and Low-Density Lipoprotein Cholesterol Levels Among Patients at High Cardiovascular Risk.” JAMA Network. 28 February 2023. Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801783.

6. Minjia Xie, et al. “Reasons for non-acceptance of statin therapy by patients at high cardiovascular risk.” Scientific Reports. 16 May 2025. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC12084616/.

7. Benefits vary according to the patient’s Cigna Healthcare plan coverage. Patients should consult their individual medical plan for coverage details.