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The American Heart Association (AHA) and the American College of Cardiology (ACC), along with nine other leading medical groups, have issued sweeping new guidelines for managing cholesterol — and they want Americans to act sooner rather than later.
Released Friday (March 13), the updated guidelines focus on dyslipidemia — an abnormal level of cholesterol or other fats in the blood. The new document serves as a comprehensive resource for doctors on how to assess and treat unhealthy lipid levels to lower a patient's risk of heart attack and stroke.
The stakes are high. An estimated one in four U.S. adults has high levels of low-density lipoprotein-cholesterol (LDL-C), commonly known as "bad" cholesterol — a condition that significantly raises the risk of heart attack and stroke.
Dr. Roger Blumenthal, chair of the guideline writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, said the changes reflect how much medical understanding has evolved. "We know 80% or more of cardiovascular disease is preventable and elevated LDL cholesterol, sometimes referred to as 'bad' cholesterol, is a major part of that risk," he said. "While we want to try to optimize healthy lifestyle habits as the first step to lower cholesterol, we realize that if lipid numbers aren't within the desirable range after a period of lifestyle optimization, we should consider adding lipid-lowering medication earlier than we would have considered 10 years ago."
Earlier Action, Healthier Outcomes
A major focus of the new guidelines is encouraging people to make healthy lifestyle changes as early as possible. Those changes include maintaining a healthy weight, getting regular physical activity, avoiding tobacco products, and prioritizing good sleep habits. When lifestyle changes alone don't bring cholesterol into a healthy range, doctors are now advised to consider prescribing cholesterol-lowering medication sooner.
The guidelines also introduce a new cardiovascular risk calculator called Predicting Risk of Cardiovascular Disease EVENTs, or PREVENT. It replaces older risk tools that were found to overestimate a person's 10-year risk of heart attack or stroke by 40% to 50%. The PREVENT calculator is designed for adults between ages 30 and 79 and uses information already collected during an annual physical — like cholesterol levels, blood pressure, age, and lifestyle habits — to give a more accurate, personalized risk assessment.
"With this new assessment tool, we can better estimate cardiovascular risk using health information already obtained during an annual physical," Blumenthal said.
Know Your Numbers
The updated guidelines also restore specific LDL-C targets. For people at borderline or intermediate risk, the goal is an LDL-C level below 100 mg/dL. For those at high risk, the target drops to below 70 mg/dL. People already living with cardiovascular disease and at very high risk should aim for an LDL-C level below 55 mg/dL.
Dr. Pamela B. Morris, vice-chair of the writing committee and director of the Seinsheimer Cardiovascular Health Program at the Medical University of South Carolina, emphasized the importance of pushing for lower numbers. "In general, lower LDL is better, especially for people at increased risk for a heart attack or stroke," she said. "Clinical trials have clearly demonstrated significant benefits for reduction in cardiovascular events when LDL-C levels are even lower than recommended in previous guidelines."
Cholesterol Risks Start Young
One of the more striking elements of the new guidelines is the emphasis on cholesterol management starting in childhood. Published in Circulation, the flagship journal of the AHA, the guidelines recommend that all children between ages nine and 11 be screened for high cholesterol if they haven't been already. High cholesterol in children can stem from inherited conditions or lifestyle habits, and early detection allows for earlier care.
"Taking action early in life is critical because high cholesterol begins to impact your heart disease risk even in adolescence," Morris said.
The guidelines were developed in collaboration with nine other medical organizations, including the American Diabetes Association, the Association of Black Cardiologists, and the National Lipid Association. Statins remain the cornerstone of drug treatment, though the guidelines also recommend newer options — including ezetimibe, bempedoic acid, and injectable PCSK9 inhibitors — for patients who need additional help lowering their LDL-C levels. Another injectable drug, inclisiran, is still being studied in clinical trials to confirm its benefits.