The American College of Cardiology, the American Heart Association, and nine other medical associations released an updated guideline for managing dyslipidemia on Mar. 13. The new document consolidates recommendations for assessing and treating abnormal blood lipid levels, including cholesterol and triglycerides, to lower the risk of atherosclerotic cardiovascular disease.
This update is significant because about one in four adults in the United States has high levels of low-density lipoprotein-cholesterol (LDL-C), which increases the risk of heart attack and stroke. The guideline aims to provide a comprehensive resource for clinicians to help reduce these risks through earlier intervention and more personalized care.
A key focus of the guideline is encouraging healthy lifestyle changes such as maintaining a healthy weight, regular physical activity, avoiding tobacco products, prioritizing sleep habits, and using cholesterol-lowering medication when recommended. "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," said Roger Blumenthal, MD, chair of the guideline writing committee. He added: "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. And lower LDL cholesterol for longer...results in much greater protection against future heart attack and stroke risk."
The guideline introduces a new cardiovascular disease risk calculator called PREVENT-ASCVD for adults aged 30-79 without known disease or subclinical atherosclerosis. This tool estimates both 10- and 30-year risks based on health information typically collected during annual checkups. It also incorporates additional factors such as family history, chronic inflammatory conditions, certain ancestries with higher risk profiles, reproductive markers like early menopause or gestational diabetes, and biomarkers including lipoprotein(a) and apolipoprotein B.
Pamela B. Morris, MD, vice-chair of the writing committee said: "In general, lower LDL is better, especially for people at increased risk for a heart attack or stroke." She noted that clinical trials have shown significant benefits from reducing LDL-C levels even further than previous guidelines recommended.
The document also addresses treatment options if lifestyle changes and statins are not enough to reach target LDL-C levels. Additional therapies may include ezetimibe or bempedoic acid (oral agents), PCSK9 monoclonal antibodies (injectables), or inclisiran (an injectable still under study). Special considerations are outlined for individuals with hypertriglyceridemia or those at increased risk due to age or inherited conditions.
Cholesterol screening is now recommended for all children between ages nine and eleven who have not been previously screened. Morris concluded: "Implementation of this important new guideline by clinicians will be critical to reduce the burden of cardiovascular disease in the future...Taking action early in life is critical because high cholesterol begins to impact your heart disease risk even in adolescence."
