'New Guideline Will Shift Statins to Younger and Lower-Risk U.S. Adults'

The new American cholesterol guideline would not make more Americans statin users per se, but instead shift the profile of people who should initiate lipid-lowering therapy to those younger and lower risk, research indicated.

Based on National Health and Nutrition Examination Survey (NHANES) cycles 2017-2023, an estimated 87.5 million (56.6%) nonpregnant U.S. adults age 30-79 years were statin eligible based on the 2026 guideline, including 21.5 million (13.9%) who were newly statin eligible. Newly statin-eligible populations were largely younger and lower risk than populations previously recommended statin therapy from the older guideline (mean estimated 10-year atherosclerotic cardiovascular disease risk 3.1% vs 6.1%).

"The 2026 dyslipidemia guideline substantially expands the U.S. population recommended for primary prevention statin therapy, predominantly in lower-risk individuals," reported a trio led by Timothy Anderson, MD, MAS, of the University of Pittsburgh, in JAMA.

"The shift to a longer view of cardiovascular disease risk is a sea change for doctors in counseling patients," Anderson said in a press release. "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."

Two accompanying studies similarly backed the finding that a large percentage of U.S. adults age 30 or older should be candidates for guideline-directed lipid-lowering therapy based on new guideline criteria.

This year's updated lipid guideline is notable for introducing the PREVENT equations as a guide for lipid-lowering therapy in primary prevention. The switch to PREVENT, known to yield risk estimates that are substantially lower than those from the older pooled cohort equations, has it that lipid-lowering therapy can now be considered with a 10-year PREVENT-ASCVD risk estimate of 3% to <5% (borderline) and should be considered for those at 5% to <10% (intermediate) 10-year risk.

One group projected that the new guideline reclassifies over one in five adults based on the PREVENT equations: two-thirds of those reassigned to lower-risk categories and one-third reassigned to higher-risk categories. Men (24.2%), Black individuals (29.6%), and current smokers (27.7%) were most frequently reassigned downward in risk, whereas women (11.1%) and individuals with diabetes (20.4%) were more often reassigned upward.

This second NHANES analysis, also in JAMA, found that the overall pool of older statin candidates would neither shrink nor grow after adoption of the PREVENT-based guideline. Using data from 1999-2020 and limited to adults age 40-79 years, investigators found that the proportion of individuals who may be recommended lipid-lowering therapy was 49.6% with the 2026 guideline versus 49.4% before the guideline, according to Allison Peng, MD, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.

"Notably, there was no significant net change in statin recommendation, suggesting that risk recalibration with PREVENT-ASCVD does not translate into fewer people recommended for evidence-based preventive therapy at the population level," the authors wrote.

Nonetheless, while the pool of overall statin candidates would stay about the same -- perhaps shifting more lower-risk -- the higher-risk cohorts were in fact the ones still furthest away from their LDL cholesterol goals, related to underuse of lipid-lowering therapy.

A third JAMA study took NHANES cycles 2021-2023 and found larger gaps in LDL cholesterol control with higher cardiovascular risk: among people age 30-79 in the primary prevention cohort, the proportion of people above the LDL cholesterol goal was an estimated 9.9% among PREVENT-estimated low-risk adults, 63.6% among borderline/intermediate-risk adults, and 82.7% among high-risk adults.

"These findings provide a contemporary population-level benchmark for the updated guideline framework," wrote Shady Abohashem, MD, MPH, of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues.

Altogether, the three studies "confirm the long-standing observation that a large percentage of U.S. adults aged 30 years or older are candidates for guideline-directed LLT [lipid-lowering therapy], and many who are currently taking LLT are not reaching new (or previous) LDL-C goals," observed JAMA editors Philip Greenland, MD, of Northwestern University Feinberg School of Medicine in Chicago, and Karen Lasser, MD, MPH, of Boston Medical Center.

"This is a huge public health burden for the U.S. population for a medical condition that should be highly treatable," they wrote in an editorial. "Given the large numbers of people who would be recommended for treatment following a risk-based discussion, these reports signify a major challenge, and so far, a missed opportunity, for the U.S. healthcare system."

Efforts to improve lipid treatment and control will require several fronts, they said, citing approaches such as multidisciplinary teams, patient education regarding statins and the new guidelines, and the policy of universal health insurance.

For one, statins remain key medications for high cholesterol, given their long history and accessibility. A growing number of nonstatin alternatives are available now, however, including the first oral PCSK9 inhibitor enlicitide (Lipfendra) for lowering LDL cholesterol, approved just a few days ago by the FDA.

Individual decision making will involve considering side effects, costs, and patient preferences, Anderson suggested.

"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," he said.

Disclosures

Anderson reported receiving grants from the National Institute on Aging during the conduct of the study; grants from the American Heart Association, U.S. Department of Veterans Affairs, CDC, and Arnold Ventures; personal fees from the American Medical Association for being an associate editor at JAMA Internal Medicine; and being a member of the 2026 dyslipidemia guideline writing committee, representing the American Geriatrics Society. Co-authors had no disclosures.

Peng disclosed receipt of grants from NewAmsterdam Pharma. Peng's co-authors disclosed relationships with Rubrum Advising, Artis Ventures, Amgen, HeartFlow, Novartis, Merck, Regeneron, Kaneka, American Heart Association, the Patient-Centered Outcomes Research Institute, the NIH, the Family Heart Foundation, Corrie Health, Prevent Medical, Boehringer Ingelheim, Genentech, Idorsia, NewAmsterdam, Eli Lilly, Novo Nordisk, and Bayer.

Abohashem reported receiving the American Heart Association Second Century Early Faculty Independence Award. Co-authors reported relationships with industry and other entities.

Greenland disclosed receipt of NIH grants. Lasser had no disclosures.

Primary Source

JAMA

Source Reference: Anderson TS, et al "Implications of the 2026 dyslipidemia guideline for primary prevention statin therapy" JAMA 2026; DOI: 10.1001/jama.2026.11246.

Secondary Source

JAMA

Source Reference: Peng AW, et al "Cardiovascular risk reclassification with the 2026 dyslipidemia guideline" JAMA 2026; DOI: 10.1001/jama.2026.11152.

Additional Source

JAMA

Source Reference: Abohashem S, et al "Prevalence of LDL-C above 2026 dyslipidemia guideline goals among US adults" JAMA 2026; DOI: 10.1001/jama.2026.10529.

Additional Source

JAMA

Source Reference: Greenland P, Lasser KE “New dyslipidemia guidelines lower the lipid treatment goals and raise the bar for clinical practice” JAMA 2026; DOI: 10.1001/jama.2026.11091.

https://www.medpagetoday.com/cardiology/dyslipidemia/122267

Hospital Price Transparency Bill Advances in the Senate

 A bill to make healthcare facilities' prices more transparent passed the Senate health committee Wednesday by a vote of 21-1, clearing the way for a vote by the full Senate.

One hundred million Americans have a combined $220 billion in medical debt, according to Sen. John Hickenlooper (D-Colo.), a cosponsor of the bill.

"People go into a hospital, get what they think is a simple procedure, and they come out impoverished," he said at a Wednesday press conference. "These are people whose lives are being twisted and diminished because they've got the anxiety and the reality of insufficient healthcare."

Where all that money goes is unclear, said Hickenlooper. "It's a completely blind system. Our bill lets patients know before they go in the hospital what it's going to cost," he added.

Hickenlooper was referring to the Patients Deserve Price Tags Act, which would require public reporting of negotiated rates, costs, and cash prices for services provided at hospitals, ambulatory surgery centers, imaging centers, and clinical labs.

"Put simply, we require the actual price to be shown, not just kind of how you get there," said Sen. Bill Cassidy, MD (R-La.), a cosponsor of the bill. "That's powerful for the patient."

The bill also ensures group health plans have access to claims data and prevents third-party administrators from restricting data access, according to a press release issued by Hickenlooper and Sen. Roger Marshall, MD (R-Kan.), the bill's chief sponsor. "Providers or facilities will also be required to include a detailed itemized bill of each distinct item or service, or an all-in total price for bundled items if offered to the patient as an option," according to the release.

And unlike previous executive orders on this topic issued by President Trump and President Biden, this one has teeth, said Hickenlooper. "There will be civil penalties for non-compliance. Hospitals won't be able to go out and collect debts if they are out of compliance," he said.

In addition, hospitals that are willfully noncompliant with the transparency law at least twice during a 1-year period will face penalties ranging from $500,000 to $10 million depending on their size.

The bill could make a difference on Americans' cost of living, saving families as much as $1,000 per month, according to Marshall. "Our bill forces transparency. It forces competition," he said.

"It's critical not to make this too abstract," said Cassidy, chair of the Senate health committee.

For example, a Louisiana family taking their child for an x-ray may not realize there's a facility fee associated with the x-ray.

"There's $500 on that healthcare bill that they didn't know was going to be there, and the family doesn't know how to pay for it," Cassidy said. "That's what this is about. Let's bring relief to that family who, at the end of the month, doesn't have the money to pay their bills."

Over in the House, a similar bill known as the Lower Costs, More Transparency Act passed out of the Energy & Commerce Health Subcommittee last month and was referred on to the full Energy & Commerce Committee. However, Marshall called that bill a "base" bill, adding, "It's something that we included in our bill, and then we closed all the loopholes." Hickenlooper agreed, saying the Senate bill was "a little more rigorous."

"Our version is more fundamental, period," said Cassidy. "It gives employers full access to their data while maintaining strong patient protection." For instance, if a patient whose employer is self-insured goes to an out-of-network provider and the insurer pays the provider $20,000 but bills the employer $60,000, "that's exposed. The employer now knows exactly what the insurance paid for that out-of-network doctor."

https://www.medpagetoday.com/practicemanagement/reimbursement/122314

Bab el-Mandeb threat level raised to 'substantial'

 The Joint Maritime Information Center (JMIC) evaluated on Thursday that the maritime threat risk for the Bab el-Mandeb Strait and Southern Red Sea had increased, raising the security threat level to "substantial" amid recent attacks.

The JMIC stated in an advisory note that Yemen's Houthis' recent declarations "continue to assert that the Bab el Mandeb is closed to Saudi-affiliated vessels, reinforcing hostile intent toward vessels perceived as linked to Saudi interests," and noted that "forward-deployed missile and drone systems near Bab el Mandeb remain in place, and regional reporting indicates the group has been instructed to remain prepared to disrupt the Red Sea oil route should broader escalation occur."

It was also stressed that additional attacks in the area are "assessed as a strong possibility."

https://breakingthenews.net/Article/Bab-el-Mandeb-threat-level-raised-to-'substantial'/66763129

Energy Department Issues Emergency Order As Hot Weather Conditions Threaten Blackouts

 The Department of Energy (DOE) issued an emergency order authorizing Southwest Power Pool Inc. to use certain energy resources to reduce the risk of potential blackouts, according to a July 21 statement from the department.

The order, issued on July 20 and signed by Secretary of Energy Chris Wright, stated that Southwest Power Pool (SPP) had asked the DOE to temporarily permit certain resources to operate beyond their normal limits to help ensure grid reliability.

SPP, the regional grid operator serving 17 states in the central United States, also sought authorization to access and deploy backup generation resources at data centers and other large industrial and commercial customer sites.

On July 20, SPP issued multiple warnings about the possibility of rolling blackouts across its service area as high temperatures drove electricity demand to record levels. One alert said SPP had been forced to rely on some or all of its operating reserves after several power plants unexpectedly went offline.

According to the order, Wright determined that additional power dispatch was necessary and that backup generation resources might be needed to address the energy emergency created by the expected strain on the grid.

The determination was based on several factors, including an anticipated electricity shortage and the potential loss of power to homes and local businesses, which could threaten public health and safety.

Wright authorized SPP to use the necessary resources to meet electricity demand. He also permitted the grid operator to deploy backup generation resources as a last resort before issuing an Energy Emergency Alert.

In its statement, the DOE said that the order took effect on July 20 and expired on July 21. The department said the measure helped reduce the risk of power outages across the regions served by SPP.

"The Trump Administration is tapping into an abundant supply of unused backup generation to maintain affordable, reliable, and secure power for hardworking American families and businesses," Wright said in the statement.

The DOE estimates that more than 35 gigawatts of backup generation capacity remains unused nationwide.

Wright said the previous administration's policies weakened the U.S. power grid, leaving Americans vulnerable during emergency events.

"Thanks to President Trump's leadership, we are reversing those failures and using every available tool to ensure Americans have continued access to affordable, reliable, and secure energy to power and cool their homes," Wright said.

As the Epoch Times notes further, On July 15, PJM Interconnection, the nation's largest electric grid operator that serves 13 states, announced a hot weather alert for its service region through at least July 17.

Such an alert is issued ahead of expected hot weather or high humidity to prepare power generation facilities and personnel to meet a surge in electricity demand.

The Midcontinent Independent System Operator, which serves 15 states, also issued an alert on July 15, citing above-normal temperatures, higher-than-forecasted loads, and power generation outages. The alert ended the same day.

High Temperatures

The emergency alerts issued by power grid operators came amid intense heat in parts of the United States.

According to a July 22 forecast by the National Weather Service's Weather Prediction Center, "hazardous heat" is expected to continue this week over the southern United States before expanding through the Great Basin and across the Northern and Central Plains.

"Forecast highs range in the mid-90s to mid-100s with heat indices exceeding 105-115 degrees for some locations," the center said.

"Widespread major to locally extreme HeatRisk (levels 3 and 4/4) is expected, which indicates a level of heat dangerous to anyone without adequate cooling or hydration."

Amid the high heat, more emergency alerts may be issued by various power grid operators, and the DOE may issue additional emergency orders to address the situation.

Elevated temperatures for the current summer season are a continuation of last year's trend. In a Jan. 13 post, nonprofit organization Climate Central said that 2025 was the fourth-hottest year on record for the contiguous United States. The nine warmest years in the country have all been recorded since 2012.

According to data from Injury Facts, an online resource run by nonprofit safety advocacy organization National Safety Council, high heat was responsible for 253 deaths in the United States last year.

https://www.zerohedge.com/markets/energy-department-issues-emergency-order-hot-weather-conditions-threaten-blackouts

Clinical trial breakthrough news drives surge in ADVB

 

Clinical trial breakthrough news drives 29% surge in ADVB shares

• On July 22 2026 Advanced Biomed announced highly promising clinical trial breakthrough results
• Stock rose 29.1% that day with extreme volatility and elevated trading volume
• Company specializes in microfluidic biochips and early cancer detection tech including lung cancer screening kits
• Recent removal of dilution risks via S-1 withdrawal and equity agreement termination amplified positive sentiment
• Positive results reported for cancer diagnosis and precision medicine platforms per multiple market reports
• Builds on prior April 2026 trial data that also triggered major gains

https://finviz.com/stock?t=ADVB&p=d

‘Widow Tax’ — and how it could reshape US great wealth transfer

 When Evelyn Delgado called her auto insurer after her husband died, she expected the bill to fall — after all, the policy now covered only one driver instead of two.

But after removing her husband, Delgado’s premium jumped by $280 a year.

“You can imagine my shock,” the Central Texas widow told legislators in 2025. “Nothing changed about me or my property, except that I lost my husband. Nothing else changed.”

Pam Kuchta had a similar experience.

“As I grieved the loss of my husband, the last thing I expected was a sudden spike in my insurance bill,” she said.

Texas has since barred home and auto insurers from changing someone’s rate solely because they became widowed, but Delgado and Kuchta’s experiences expose a financial contradiction that is only growing in scale and impact.

Widowhood can reduce a household’s income while leaving the cost of sustaining the same life unchanged — or even higher.

The ‘widow tax’ is not one tax

Of the $124 trillion in assets that Cerulli Associates estimates will change hands through 2048, $54 trillion is first expected to pass between spouses.

7

The capital gains tax exclusion protects less as the asset has gotten more expensive.National Association of Realtors

Of that sum, more than 95% will go to women.

But inheriting the household’s assets doesn’t preserve the income that supported them.

A surviving spouse may keep the house, retirement accounts, and other wealth while losing one Social Security payment and moving into less favorable tax and Medicare thresholds.

Estate-planning attorneys sometimes use the term “widow tax” to describe that collection of disadvantages.

“‘Widow tax’ suggests a single line item, and in my experience it’s really a convergence of several ordinary rules that all land the same year,” explains Jonathan White, an estate planning attorney.

Social Security is often the first hit.

A surviving spouse keeps the larger of the couple’s two benefits, but the household still loses one monthly payment. So while an individual benefit can climb, household income still falls.

That impact has had a dramatic and measurable impact on widows, in particular.

Among women whose husbands claimed Social Security at full retirement age, widowhood increased the probability of falling into the bottom 5% of their pre-widowhood income distribution by 6.9 percentage points, according to a 2026 TIAA Institute study by economist Sita Slavov.

In plain terms, that means becoming far more likely to end up with less income than 95% of women in the study had before widowhood.

What income remains after widowhood also often receives far less favorable treatment.

Just one year after the death of a spouse, the survivor loses the ability to file a joint tax return unless another filing status applies, subjecting required minimum distributions and other retirement income to single-filer tax brackets.

In 2026, the standard deduction is $32,200 for married couples filing jointly but $16,100 for single filers, according to the Internal Revenue Service.

The 22% tax bracket begins above $50,400 in taxable income for a single filer—exactly half the $100,800 threshold for a couple filing jointly.

Medicare’s income-related surcharges also begin at substantially lower income levels for individual filers than for married couples filing jointly.

In 2026, income-related surcharges begin above $109,000 for an individual, compared with $218,000 for a married couple filing jointly—so a widow can cross the threshold even if household income has fallen substantially.

It’s a complicated web of falling income and increasing exposure, but White says surviving spouses should pay attention to two, in particular.

“The changes with the greatest effect are the shift to single-filer income tax brackets and the Medicare IRMAA cliff, because those thresholds for a single filer sit at roughly half the married thresholds, not because the surviving spouse’s income actually falls in half,” he says.

Same house can consume far more of widow’s income

Nowhere is the strain more obvious than the house itself, though.

As many as 35% of recently widowed older homeowners spent at least 30% of their income on housing, the threshold commonly used to define housing-cost burden, according to a 2022 study from the Consumer Financial Protection Bureau.

Among homeowners aged 60 and older overall, the comparable rate was 22%, meaning the housing-cost-burden rate was approximately 59% higher among recently widowed homeowners.

White says it’s something he sees in his own practice.

“The survivor stays in a house sized for two people, and the carrying costs (taxes, insurance, heating, deferred maintenance) keep draining liquid assets while the equity sits untouched,” he explains.

And in recent years, those carrying costs have become substantially more expensive.

Property taxes rose 31% nationally between 2019 and 2025, while average monthly homeowners insurance premiums increased 72%, according to the Harvard Joint Center for Housing Studies’ State of the Nation’s Housing 2026 report.

Residential electricity costs rose more than 30% between 2020 and 2025.

Selling can release equity—but starts another calculation

Selling the family home and downsizing might seem like the obvious solution, then. But that seemingly straightforward answer runs straight into the hidden home equity tax.

Today, an estimated 13.1 million homeowners have gains above their applicable exclusion limit, according to research from the National Association of Realtors®.

That’s due in large part to long-tenured homeowners remaining in their homes long enough for price appreciation to outpace what the exclusion protects.

But widows who have lived in their homes for decades face an even more unusual exposure: The protection available to a married couple can shrink soon after one spouse dies.

For a surviving spouse, the larger exclusion generally remains available only if the sale closes within two years of the spouse’s death and the other requirements are met.

After that window, the survivor is generally limited to the $250,000 exclusion.

“So a couple who could have sold with no tax consequence while both were alive can find that the same sale, made three years after one spouse dies, generates a real bill, even though the house hasn’t appreciated any further in that time,” White says.

“I tell clients: If you’re going to sell, know that two-year clock and plan around it deliberately. Don’t let it pass by default.”

But allowing the two-year window to expire doesn’t automatically create a tax bill—as a second rule may work in the survivor’s favor.

When one spouse dies, the tax basis of some or all of the home may be adjusted to its fair market value on the date of death. Because taxable gain is calculated against that basis, the adjustment can erase much of the appreciation that accumulated during the marriage and reduce—or sometimes eliminate—the gain on a later sale.

“Two things change at once,” White says. “Part or all of the home’s cost basis gets stepped up to fair market value as of the date of death, which can erase most of the taxable gain built up over the marriage. At the same time, the survivor’s capital gains exclusion on a future sale drops from $500,000 to $250,000 unless the sale closes within two years of the death.”

The survivor then has to weigh both rules together: the possible loss of the larger exclusion and the possible basis adjustment created by the spouse’s death.

The state and the deed can change the tax bill

But how much of the home’s basis is adjusted can depend on where the couple lived and how they owned the property.

“In a community-property state, both halves of the home get a full step-up in basis at the first spouse’s death, even the half the surviving spouse already owned,” White says. “In Massachusetts and most other common-law states, only the deceased spouse’s half gets stepped up; the survivor’s half keeps its original, often much lower, basis.”

Consider two couples who bought equally priced homes at the same time and experienced identical appreciation. If one home receives a full basis adjustment at the first spouse’s death and the other receives an adjustment only on the deceased spouse’s share, the surviving owners could face very different taxable gains upon sale.

Matt Odgers, a California estate planning attorney, says the distinction can eliminate decades of taxable appreciation in a community-property state.

“When one spouse dies in a community-property state, the home’s entire cost basis resets to its value that day,” Odgers says. “Decades of appreciation can disappear for tax purposes in a single moment.”

But living in a community-property state isn’t necessarily enough. The language on the deed and the form in which the couple held title can affect whether the property receives community-property treatment. That makes the ownership documents nearly as important as the home’s purchase price, current value, and eventual sale price.

Largest threat to estate may come after tax questions

Even when a survivor can sell the house with a solid profit, the property’s equity may not reach the couple’s children or other heirs.

Longer life spans and higher costs are expected to consume much of the Great Wealth Transfer’s wealth before it can ever be passed on. Of the $93 trillion in assets that boomers hold today, only $36 trillion could reach Gen X and millennial heirs over the next 20 years, according to Visa Business and Economic Insights.

“Long-term care is the biggest [expense] by a wide margin,” White says. “A surviving spouse who needs assisted living or memory care is often paying $8,000 to $15,000 a month privately, and that draws down savings fast, especially once it runs for several years.”

The home may eventually become the largest practical source of money available to pay for that care, forcing a sale even when the survivor is not emotionally prepared to move, market conditions are unfavorable, or a different timeline would have produced a better tax result.

“In California, the family home often reaches a surviving spouse nearly tax-free,” Odgers says. “What quietly erodes the estate is everything that happens in the years between the two deaths.”

Costly mistake allowing decisions to happen by default

The death of a spouse can start several financial clocks at the moment the survivor is least prepared to make permanent decisions—and that may be the most costly toll.

“I’ve seen families lose real money simply because nobody revisited the plan after the first spouse died, not because anyone did anything wrong, just because grief and administrative fatigue delayed decisions that had actual deadlines attached to them,” White says.

https://nypost.com/2026/07/23/real-estate/the-widow-tax-could-reshape-the-great-wealth-transferstarting-with-the-family-home/