The American College of Cardiology and the American Heart Association released new national guidance for managing cholesterol and blood lipids on Mar. 23, emphasizing earlier risk assessment, personalized treatment, and long-term prevention strategies that could begin as early as age 30. Experts say this approach may significantly reduce heart attacks and strokes over a lifetime.
The updated recommendations reflect evidence that long-term exposure to elevated LDL cholesterol increases cardiovascular risk by causing plaque buildup in arteries. With an estimated one in four U.S. adults having high LDL levels, there is a focus on earlier detection and intervention.
NYU Langone Health faculty contributed to the development of these guidelines. Harmony R. Reynolds, MD, director of NYU Langone's Cardiovascular Clinical Research Center, served on the guideline writing committee, while Sunil Rao, MD, director of interventional cardiology at NYU Langone Health, serves as chair-elect overseeing all cardiovascular clinical guidelines for ACC/AHA.
Published simultaneously in two leading journals on March 13, the new guideline replaces previous standards from 2018. It introduces tools such as the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator to estimate both ten- and thirty-year risks for adults aged 30 to 79 based on factors like body mass index and tobacco use.
"Rather than waiting until someone is at the highest risk, we now have better tools to identify risk earlier and take action sooner," said Dr. Reynolds. "We're shifting from focusing only on 10-year risk to also looking at 30-year risk, recognizing that cardiovascular disease develops over a lifetime." The guidance also recommends additional biomarker testing—including lipoprotein(a) and apolipoprotein B—and coronary artery calcium scoring for more precise patient care decisions.
"Cholesterol care isn't one-size-fits-all," said Dr. Reynolds. "These additional tools give us a clearer picture of each patient so we can make more personalized decisions." The guideline stresses keeping LDL levels low: below 100 mg/dL for most people without major risks; under 70 mg/dL for those with diabetes or higher heart disease chances; and below 55 mg/dL for individuals who have already experienced heart attacks or strokes.
If lifestyle changes or statins are not enough to lower cholesterol sufficiently, newer oral medications or injectable therapies are available options according to the guideline's recommendations.
"In general, lower LDL is better especially over a longer period of time," said Dr. Reynolds. "Reducing exposure earlier in life can have a meaningful impact on long-term cardiovascular risk." The document also notes that high cholesterol may affect children due to genetics or lifestyle factors; screening between ages nine and eleven is advised when appropriate.
"Half of people with high LDL cholesterol don't have a family history of heart disease," said Dr. Reynolds. "Heart disease is common...so checking and understanding your numbers is critical." Ultimately these updates mark a shift toward proactive prevention rather than later-life treatment: "If there's one place to start it's simple: Get up and move," Dr. Reynolds said.
