Updated cholesterol guidelines aim to reduce heart disease risk

Dr. JANEL GORDON
WISH-TV Medical Expert
WISH-TV | wishtv.com

The American Heart Association, American College of Cardiology and nine other major medical organizations earlier this month released new cholesterol screening and management guidelines.

An estimated one in four U.S. adults have elevated LDL cholesterol, or low-density lipoprotein, is commonly known as “bad” cholesterol because high levels lead to plaque buildup in arteries. Elevated LDL cholesterol increases the risk of atherosclerotic cardiovascular disease (ASCVD), including heart attack and stroke.

Cholesterol screening is recommended starting in childhood, from ages 9 to 11. People should be screened again at age 19 and every five years.

The American Heart Association in 2023 development a risk calculator called Predicting Risk of Cardiovascular Disease EVENT, or PREVENT. Physicians and other health care professionals can assess the 10- and 30-year risk estimates for heart attack and stroke in people ages 30 to 79. The calculator was based on data from 6.6 million people. The previous risk calculator was based on 26,000 people and calculated risks starting at age 40.

The PREVENT calculator uses factors including age; gender; blood pressure; cholesterol; personal history or presence of overweight or obesity; diabetes or chronic kidney disease; and smoking status. The calculator should not be used to assess people with familial hypercholesterolemia, a genetic disorder.

Risks can be further personalized based on additional factors including a personal history or presence of chronic inflammatory conditions such as lupus or rheumatoid arthritis; gestational diabetes; gestational high blood pressure; preeclampsia preterm delivery; early menopause; and family history of heart disease.

For people with intermediate risks, LDL cholesterol levels should be below 70 milligrams per deciliter. People with higher risks should have a goal for a LDL cholesterol level below 55 milligrams per deciliter.

The new guidelines also call for additional testing to further assess cardiovascular disease risk. One of these tests is lipoprotein(a). Lp(a) may be stickier than LDL cholesterol and speed up the narrowing of the arteries. It is genetic and not altered by lifestyle interventions. Adults should have their level checked at least once.

Lifestyle interventions should be the first step in improving risks. People should work with their health care team to eat whole food, plant-forward meals that are lower in saturated fat; engage in moderate to vigorous physical activity, including two days of strength training; avoid tobacco; get restful sleep; and maintain a healthy weight. From 80 percent to 90 percent of cardiovascular disease is attributable to modifiable risk factors.

Statins remain the primary choice for pharmacological intervention, especially for people 40 and older with diabetes, chronic kidney disease stage 3 or 4, or HIV. Additional therapeutic options are available, if needed, to lower LDL cholesterol and triglycerides, which also contribute to cardiovascular disease risk. People who are pregnant, breastfeeding and in the process of conceiving, should not utilize lipid-lowering medications.

The 2026 Guideline on the Management of Dyslipidemia is a report of the American College of Cardiology and the American Heart Association Joint Committee on Clinical Practice Guidelines, developed in collaboration with and endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, the Association of Black Cardiologists, the American College of Preventive Medicine, the American Diabetes Association, the American Geriatrics Society, the American Pharmacists Association, the American Society for Preventive Cardiology, the National Lipid Association and the Preventive Cardiovascular Nurses Association.

This story was originally published by WISH-TV at wishtv.com/news/health-spotlight/updated-cholesterol-guidelines-aim-to-reduce-heart-disease-risk.