New cholesterol guidelines released Thursday by the American Heart Association and 10 medical groups recommend earlier screening, stricter LDL cholesterol targets and broader risk testing to reduce heart attack and stroke risk.
Experts Push Earlier Cholesterol Screening
Leading cardiovascular organizations issued New cholesterol guidelines aimed at improving prevention among the estimated 86 million U.S. adults living with high cholesterol, a major contributor to heart disease and stroke.
The recommendations call for cholesterol testing in children around age 10 to identify inherited conditions such as familial hypercholesterolemia, which affects about one in 250 people. Screening should resume around age 19 and continue at least every five years.
“We have much more data that getting the LDL down earlier for longer periods can be very helpful at lowering a person’s long-term risk,” said Dr. Roger Blumenthal, chair of the guideline writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.
Experts say earlier detection allows doctors to intervene sooner through lifestyle changes or medication when needed, particularly for patients with strong family histories of heart disease.
New Risk Calculator Changes Treatment Decisions
The new Cholesterol Guidelines introduce PREVENT-ASCVD, a new calculator designed to estimate heart disease risk over 10- and 30-year periods for adults ages 30 to 79.
Clinicians are encouraged to use the tool when deciding whether patients should begin cholesterol-lowering medications such as statins. The guidelines recommend considering treatment when a patient’s 10-year risk reaches five percent.
“Maybe your 10-year risk is pretty low, but your 30-year risk might be one in three,” Blumenthal said. “That usually gets their attention.”
Dr. Ian Neeland, a cardiologist and associate professor at Case Western Reserve University School of Medicine who was not involved in drafting the guidelines, said the calculator represents progress in prevention strategies.
“The inclusion of the PREVENT equations is a step forward for risk prediction,” Neeland said. “It’s a great addition to the repertoire that we have to assess risk.”
The guidelines also lower recommended LDL cholesterol targets for many patients. Most adults should aim for LDL levels below 100 milligrams per deciliter. Those with higher cardiovascular risk should target levels below 70 mg/dL, while patients with established heart disease should aim for 55 mg/dL or lower.
“These are treatment targets clinicians are going to want to obtain with statins and other therapies,” Neeland said.
Guidelines Recommend LP (a) Testing, Warn Against Supplements
Another major update advises that all adults receive at least one test for lipoprotein(a), or Lp(a), a largely inherited cholesterol particle linked to plaque buildup in arteries. About one in five people worldwide has elevated levels.
Blumenthal described Lp(a) as a “risk enhancer” rather than a treatment target, noting that aggressive LDL reduction can offset increased risk associated with high readings.
However, some experts urge caution. Neeland said routine testing could cause anxiety because direct treatments for Lp(a) remain limited.
The New Cholesterol Guidelines also discourage relying on dietary supplements to lower cholesterol. A 2023 clinical study found that a low-dose statin reduced LDL cholesterol by about 35%, while supplements such as fish oil, garlic, turmeric and red yeast rice showed no meaningful benefit compared with a placebo.
“We’ve known for a long time that many patients are skeptical of prescription medicine, yet they may have a bag full of unproven supplements,” Blumenthal said.
Researchers emphasized that prescription medications and lifestyle changes remain the most effective strategies for reducing cardiovascular risk.
Health experts say the updated recommendations reflect growing evidence that earlier action and more aggressive cholesterol control can prevent future heart disease and save lives.
