What to Know About New Cholesterol Guidelines

For years, heart health has been something many people didn’t think about until their 40s, 50s or later, but new guidelines are clear that prevention should start much sooner, in your 30s. Backed by the American Heart Association and American College of Cardiology, these updated recommendations focus on catching risk earlier and taking action before problems build up.

At the center of it all is cholesterol. Specifically, keeping an eye on “bad” cholesterol (LDL) and other fats in your blood that can lead to plaque buildup in the arteries.

The updated guidelines center on three key components:

• Earlier testing -- Annual screenings for all adults beginning at age 30, and children should be tested at least once for cholesterol around age 10
• Lower targets -- LDL should be below 100 for those at lower risk of heart issues; Patients with higher risk should aim for an LDL of 70 or below
• Additional screenings -- All adults should have their lipoprotein (a) tested at least once and consider adding apolipoprotein B to annual labs

Earlier Testing + Prevention

Starting in your 30s, doctors are encouraged to not only check your cholesterol but to use a newer risk calculator called PREVENT to get a clearer picture of your chances of developing heart disease over the next 10 to 30 years. This is especially important if you have a family history of heart issues, high blood pressure, type 2 diabetes, or if you smoke.

Focusing on prevention earlier brings up important conversations between you and your doctor. Those annual wellness visits are a good time to discuss lifestyle changes that could improve your heart like healthier eating, regular exercise, and quitting smoking.

But sometimes lifestyle changes don’t quite do enough. In the past, treatment with statins — medications that lower cholesterol — was often delayed until risk was higher. But now based on the bigger risk picture, medication may be recommended earlier, even for people who aren’t considered “high risk” yet, if their overall risk adds up over time. The guidelines suggest considering statins for adults 30 and up with LDL levels of 160 or higher.

Even if your risk falls into a “borderline” or “intermediate” category, your doctor may still recommend treatment sooner than before. That doesn’t mean everyone needs medication right away, but it does open the door for earlier conversations.

Lower Targets + More Treatment Options

The new guidelines add back in clear targets for LDL cholesterol numbers. LDL should be below 100 for those at lower risk of heart issues, and patients with higher risk should aim for an LDL of 70 or below.

If a lifestyle changes and statins are still not cutting it to lower your LDL cholesterol, doctors may now suggest adding newer, non-statin options like a different oral medication and injectable therapy.

Additional Screenings

Cholesterol tests are getting a little smarter. The guidelines now suggest adding a test for apolipoprotein B, or apoB, in certain cases. This protein sits on the surface of the “bad” particles in your blood, including LDL, that contribute to plaque buildup.

Even if your LDL number looks okay, apoB can give a more detailed look at how many harmful particles are actually circulating in your bloodstream. More particles can mean more risk. Your routine lipid panel may not include this test, so talk to your doctor about your potential risk and if this tool could be helpful for you.

Another key update is the recommendation that everyone get tested at least once for lipoprotein(a), or Lp(a). This type of cholesterol isn’t picked up on standard tests, but it plays a big role in heart disease risk.

What makes Lp(a) unique is that it’s mostly determined by your genes, not your diet or lifestyle. That means even people who eat well and exercise regularly could still have elevated levels. And for those who do, the risk of plaque buildup in the arteries can be significantly higher.

Because it’s something you’re born with, you typically only need to test for it once. But knowing your number can help your care team decide how aggressive to be with prevention strategies moving forward.

The bottom line is that heart disease doesn’t start overnight, and neither should prevention. These updated guidelines are all about getting ahead of risk earlier, using better tools, and having more proactive conversations about your health. If you’re in your 30s (or getting close), it might be time to check in on your numbers and start the conversation.