New Guidelines Aim to Prevent Heart Disease with Earlier Cholesterol Screening

WASHINGTON — New preventative screening guidance aims to identify and treat cholesterol risks well before they could lead to heart disease. The updated guidelines, released Friday by the American Heart Association (AHA), the American College of Cardiology (ACC), and other leading medical groups, offer a comprehensive “one-stop shop” for assessing and treating blood lipids 1.

The Scope of the Problem

Roughly 1 in 4 U.S. Adults have high levels of low-density lipoprotein cholesterol (LDL-C), often referred to as “bad” cholesterol. High LDL-C levels are associated with an increased risk of heart attack and stroke 1.

Preventing Cardiovascular Disease

According to the report, about 80% or more of cardiovascular disease is preventable, with elevated LDL-C being a major contributing risk factor 1. The new guidance emphasizes looking beyond simply testing LDL-C and triglycerides to gain a more complete picture of a patient’s risk.

Introducing PREVENT-ASCVD

One of the most significant changes is the adoption of a new risk calculator, called PREVENT-ASCVD, designed for adults between 30 and 79 years old. This replaces the older Pooled Cohort Equations for 10- and 30-year risk assessment 3. The updated risk categories classify 10-year risk as:

• Low (under 3%)
• Borderline (3–5%)
• Intermediate (5–10%)
• High (10% or more)

Risk Enhancers and Additional Testing

The PREVENT-ASCVD calculation can be further refined by considering “risk enhancers,” factors that could accelerate earlier or more aggressive treatment. Doctors are similarly encouraged to consider three additional tests to help screen for risk factors 3:

• Selective use of a non-contrast artery calcium (CAC) scan
• Lipoprotein (a), or LP(a)
• Apolipoprotein B, or apoB

CAC scans are non-invasive and help measure calcified plaque buildup in arteries. Screening for lipoprotein(a) (LP(a)) involves a one-time blood test during adulthood to identify a genetic risk marker for heart disease. Elevated levels can indicate inherited risks for stroke, heart attack, and other cardiovascular illnesses. The apolipoprotein B (apoB) test helps identify residual risk for deposits on blood vessel walls.

A More Comprehensive Approach

“Having healthy LDL-cholesterol levels or high-density lipoprotein-cholesterol (HDL-C), traditionally thought of as ‘good’ cholesterol, isn’t necessarily a ‘get out of jail free’ card,” said Dr. Roger Blumenthal, chair of the guideline writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore 3. “Measuring other biomarkers can give a more complete picture of someone’s cardiovascular risk and help inform decisions about whether lipid-lowering therapy is needed sooner rather than later or if more intensive therapy is warranted.”

The guideline consolidates evidence-based recommendations for managing dyslipidemias, retiring and replacing the 2018 Guideline on the Management of Blood Cholesterol 3. It also emphasizes earlier intervention through healthy lifestyle changes, starting in childhood, and considers pharmacotherapy in youth with familial hypercholesterolemia.