New Cholesterol Guidelines Emphasize Early Screening and Prevention

WASHINGTON — New preventative screening guidance aims to identify and treat cholesterol risks well before they can lead to heart disease. The updated guidelines, released Friday, March 13, 2026, by the American Heart Association, the American College of Cardiology, and other leading medical groups, offer a comprehensive approach to assessing and treating blood lipids.

The Scope of the Problem

Roughly one in four U.S. Adults has high levels of low-density lipoprotein cholesterol (LDL-C), often referred to as “bad” cholesterol. High LDL levels are associated with an increased risk of heart attack, and stroke. According to experts, approximately 80% or more of cardiovascular disease is preventable, with elevated LDL-C being a major contributing risk factor.

Key Changes in the Guidelines

The new guidance moves beyond simply testing LDL-C and triglycerides, focusing on a more comprehensive evaluation of cardiovascular risk. Several key changes are included:

New Risk Calculator: PREVENT-ASCVD

The guidelines introduce the PREVENT-ASCVD risk calculator for adults aged 30 to 79, replacing older screening methods. This calculator categorizes 10-year risk as:

• Low: Under 3%
• Borderline: 3–5%
• Intermediate: 5–10%
• High: 10% or more

Risk Enhancers

The calculation can be refined by considering “risk enhancers” – factors that may warrant earlier or more aggressive treatment.

Additional Testing

Doctors are encouraged to consider three additional tests to help screen for risk factors:

• Selective use of a non-contrast artery calcium (CAC) scan: This non-invasive scan measures calcified plaque buildup in arteries.
• Lipoprotein(a), or LP(a): A one-time blood test to identify a genetic risk marker for heart disease.
• Apolipoprotein B, or apoB: Helps identify residual risk for deposits on blood vessel walls.

The Importance of a Comprehensive Approach

“Having healthy LDL-cholesterol levels or high-density lipoprotein-cholesterol (HDL-C), traditionally thought of as ‘quality’ 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. “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.”

Early Intervention

The guideline emphasizes earlier intervention through healthy lifestyle changes, starting in childhood. Early consideration of pharmacotherapy is recommended for youth with familial hypercholesterolemia (FH) and in young adults with LDL-C ≥160 mg/dL or a strong family history of premature atherosclerotic cardiovascular disease (ASCVD).

Statin therapy remains a primary recommendation for high-risk patients, but the guidelines also acknowledge the potential value of non-statin therapies in certain cases.