New guidelines for managing cholesterol suggest more aggressive prevention and earlier treatment. This includes a recommendation for all adults to get a one-time test for lipoprotein(a). This is a genetic marker that can show a risk for heart disease.
The American Heart Association and the American College of Cardiology released these updated guidelines. They aim to give doctors more tools to assess heart disease risk. Heart disease is the leading cause of death for both men and women in the U.S.
Understanding Your Risk
Dr. Roger Blumenthal, a cardiologist at Johns Hopkins, chaired the guideline committee. He noted that over 80% of cardiovascular disease is preventable. High LDL cholesterol, often called "bad" cholesterol, is a major risk factor.
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Start Your News DetoxHowever, knowing only your LDL levels might not be enough. Blumenthal explained that checking other markers can give a fuller picture of someone's heart risk. This helps doctors decide if cholesterol-lowering therapy is needed sooner.
One key new recommendation is a single lipoprotein(a) test for all adults. This is a simple blood test that is widely available. Many primary care doctors now offer it as part of routine preventive care.
Since lipoprotein(a) levels are genetic and stay stable, the test usually only needs to be done once. It's best to do it early in adulthood. High levels indicate an inherited risk for heart attacks, strokes, and other heart conditions.
The guidelines also suggest wider use of coronary calcium scoring. This is a noninvasive scan that checks for calcified plaque in the arteries. Doctors are also encouraged to use the PREVENT risk assessment tool. This tool can predict a patient's 10-year and 30-year risk of heart disease. This helps guide decisions about starting medication.
Earlier Treatment and Lifestyle Changes
Statins, which are cholesterol-lowering drugs, remain the main treatment for high cholesterol. The new guidelines suggest considering these medications even for patients with relatively low risk, if their overall lifetime risk profile supports it.
Dr. Steven Nissen, a preventive cardiologist at Cleveland Clinic, called this a "sea change." He emphasized that a person's lifetime risk is what truly matters.
Nissen believes these new guidelines will lead to more people getting treated earlier. Statins are relatively inexpensive, with generic versions available. Nissen noted his own statin prescription costs about $3 per month.
About 25% of U.S. adults have high levels of LDL cholesterol. This increases their risk of heart attacks and strokes. Nissen expects the guidelines to affect millions, leading to more people being treated with statins and other LDL-lowering medicines. He stressed that an earlier, more intense preventive approach could greatly reduce heart attacks, strokes, and overall cardiovascular disease.
The guidelines also highlight the importance of daily habits. These include regular physical activity, avoiding tobacco, and getting enough sleep. Leslie Cho, another preventive cardiologist at Cleveland Clinic, stated that diet and exercise are the foundation of good heart prevention.
The guidelines are published in the journal Circulation and in JACC, the Journal of the American College of Cardiology.
Deep Dive & References
2026 ACC/AHA Guideline for the Management of Dyslipidemia - JACC, 2026
