5 Must-Know Updates in the New Cholesterol Guidelines

The American Heart Association, together with 10 other major medical groups, has released new guidelines for managing cholesterol. These recommendations are designed to help the 86 million adults in the United States who have high cholesterol, which is a major risk factor for heart attack and stroke. The updated guidelines explain better ways to measure a person’s risk of heart disease, when treatment should begin, and how cholesterol should be lowered to protect heart health. They also encourage earlier cholesterol testing and provide clearer goals for treatment. These updates aim to help doctors identify risks earlier and prevent heart problems before they happen.

Cholesterol Testing Should Start Earlier

One important update in the new guidelines is that cholesterol testing should begin earlier in life. Experts now recommend that children should have a cholesterol test around the age of 10. This test mainly helps doctors detect familial hypercholesterolemia, a condition that runs in families in which people are born with very high LDL cholesterol, often called “bad” cholesterol. This condition affects about one in 250 people in the United States. Detecting it early can help doctors start treatment sooner and lower the risk of serious heart problems later in life. After childhood testing, cholesterol screening should begin again around age 19 and continue at least every five years. Doctors may recommend earlier treatment for young adults whose LDL levels are 160 mg/dL or higher or who have a strong family history of early heart disease. Research shows that lowering LDL cholesterol early and keeping it low for many years can greatly reduce the risk of heart disease.

A New Tool to Measure Heart Disease Risk

Another change in the guidelines is the introduction of a new tool called PREVENT-ASCVD to measure heart disease risk. ASCVD refers to heart and blood vessel disease caused by plaque buildup inside the arteries. This buildup can block blood flow and lead to heart attacks or strokes. The PREVENT-ASCVD calculator estimates a person’s risk of developing heart disease over the next 10 years and 30 years. It uses several health factors, including age, blood pressure, cholesterol levels, and other medical information. The calculator is designed for adults between the ages of 30 and 79. Doctors can use this tool to decide whether a patient should start cholesterol-lowering medicines such as statins. According to the guidelines, medication may be recommended if a person’s 10-year risk reaches 5%. The calculator can also help people understand their long-term risk. For example, someone may have a low risk over the next 10 years but a much higher risk over the next 30 years.

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Lower LDL Targets for Many Patients

The new guidelines also suggest lower LDL cholesterol targets for some people. Most individuals should aim to keep their LDL cholesterol below 100 milligrams per deciliter (mg/dL). However, people who have a higher risk of heart disease may need even lower levels. If a person’s 10-year risk of heart disease is at least 10%, the recommended LDL target is below 70 mg/dL. People who already have heart disease or who have had a heart attack or stroke should aim for LDL levels below 55 mg/dL. Doctors usually try to reach these goals using statins and other cholesterol-lowering medicines. Lowering LDL cholesterol helps reduce fat buildup in the arteries and lowers the risk of heart attack and stroke. Studies show that keeping LDL levels lower can provide stronger protection against heart disease, especially for people at higher risk.

Lp(a) Testing Is Now Recommended for Everyone

Another important recommendation in the guidelines is that adults should have their lipoprotein(a), or Lp(a), measured at least once in their lifetime. Lp(a) is a type of fat particle in the blood that carries cholesterol. It is similar to LDL cholesterol but has an extra protein that makes it more likely to cause plaque buildup in the arteries. Lp(a) levels are mostly determined by genes and usually remain stable throughout a person’s life. About one in five people worldwide have high Lp(a) levels, which can increase the risk of heart disease and stroke. Although there are currently limited treatments that directly lower Lp(a), testing can still help doctors better understand a patient’s overall risk. If Lp(a) levels are very high, doctors may recommend stronger treatment to lower LDL cholesterol and reduce the risk of heart disease.

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Don’t Rely on Supplements to Lower Your Cholesterol

The new guidelines also warn against relying on supplements to lower cholesterol. Many people take supplements such as fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice in the hope that they will reduce cholesterol levels. However, research shows that these supplements do not lower LDL cholesterol as effectively as prescription medicines. A study in 2023 compared a low-dose statin with a placebo and several supplements. The results showed that the statin lowered LDL cholesterol by about 35%, while the supplements did not produce a meaningful decrease compared with the placebo. Another concern is that supplements are not regulated as strictly as prescription medicines. This means their safety, strength, and quality may not always be guaranteed. Because of this, experts say that proven prescription medicines are usually the best option for people who need to lower their cholesterol.