Cholesterol guidelines updated: US doctors push for earlier screening and better heart risk assessment

US cardiologists have issued updated guidelines for managing cholesterol, putting greater emphasis on early screening, personalised heart-disease risk assessment, and keeping “bad” LDL cholesterol lower for longer.

The new guidance from the American College of Cardiology (ACC) and American Heart Association (AHA) updates recommendations that have been in place since 2018. ScienceAlert reported that the changes reflect growing evidence that prolonged exposure to high cholesterol can contribute to cardiovascular disease later in life.

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Cholesterol screening to begin earlier

One of the notable changes is the push for cholesterol testing earlier in life. According to the updated recommendations, children should have their cholesterol checked between the ages of 9 and 11, while testing can begin as early as age 2 for children with a strong family history of high cholesterol or early cardiovascular disease.

The idea is to identify elevated cholesterol before years of exposure can contribute to artery damage.

New LDL cholesterol targets

The guidelines bring back specific LDL cholesterol targets based on a person's cardiovascular risk.

For people at borderline or intermediate risk, the recommended LDL-C goal is below 100 mg/dL. For those at high risk, the target is below 70 mg/dL. People with existing cardiovascular disease who are at very high risk are advised to aim for an LDL-C level below 55 mg/dL.

“In general, lower LDL is better, especially for people at increased risk for a heart attack or stroke,” Pamela B. Morris, vice-chair of the guideline writing committee, said, according to the American Heart Association.

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Doctors to assess overall heart risk

The new recommendations also encourage doctors to look beyond cholesterol numbers alone.

The updated PREVENT-ASCVD equations can be used to estimate a person's 10-year and 30-year risk of cardiovascular disease. Doctors can then combine this assessment with other risk factors before deciding whether medication is necessary.

This means two people with similar cholesterol levels may not necessarily receive the same treatment.

Lp(a) testing gets more attention

The guidelines also recommend that adults have their lipoprotein(a), or Lp(a), level measured at least once. Lp(a) is an inherited type of cholesterol-carrying particle that can contribute to cardiovascular risk.

The updated guidance also recognises the usefulness of additional markers such as apolipoprotein B (ApoB) for selected patients.

Lifestyle remains important

Despite the stronger focus on cholesterol-lowering treatment, the guidelines continue to stress healthy lifestyle choices.

A balanced diet, regular physical activity, maintaining a healthy weight and avoiding tobacco remain important parts of reducing cardiovascular risk. When lifestyle changes alone are not sufficient, doctors may consider medications such as statins and other LDL-lowering therapies.

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What the new guidelines mean

The biggest change is a move towards earlier and more personalised cholesterol management rather than waiting until a person develops obvious cardiovascular disease.

As ScienceAlert reported, the updated approach reflects the understanding that cholesterol exposure accumulates over time. Detecting elevated levels earlier and treating people according to their individual risk could help prevent heart attacks and strokes later in life.