New cholesterol guidelines could change when you get tested
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New cholesterol guidelines could change when you get tested
Start earlier, personalize more: a new guideline aims to stop heart disease decades before it strikes.
Date:
March 29, 2026
Source:
Johns Hopkins Medicine
Summary:
A major new U.S. cholesterol guideline is shifting the focus toward earlier, more personalized prevention of heart disease. It urges people to start screening sooner—sometimes even in childhood—and highlights the importance of tracking not just LDL (“bad”) cholesterol but also genetic risk factors like lipoprotein(a). A new, more advanced risk calculator now uses broader health data to better predict heart attack and stroke risk over decades.
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A new cholesterol guideline calls for earlier testing and more tailored risk assessments to prevent heart disease. It combines lifestyle changes, improved screening tools, and expanded treatment options to better protect long-term health. Credit: Shutterstock
For the first time since 2018, the American College of Cardiology and the American Heart Association have released updated clinical guidance on how to screen for and manage blood cholesterol. The recommendations were published in the Journal of the American College of Cardiology and Circulation and were presented March 28 at the American College of Cardiology's 75th Annual Scientific Session in New Orleans.
The release comes shortly before a related paper, "The ABCs of Cardiovascular Disease Prevention: Communicating What We Know in 2026," appeared in the American Journal of Preventive Cardiology.
Focus on LDL, Lipids, and Personalized Risk
The updated guidance centers on lowering low-density lipoprotein (LDL) cholesterol, commonly known as bad cholesterol, along with other blood fats such as lipoprotein(a), or Lp(a). It also highlights the need for earlier screening, particularly for people with a family history of heart disease, and calls for more individualized risk assessments based on factors like existing health conditions. These steps are intended to support more informed, shared decisions between patients and clinicians.
"We know that lower LDL cholesterol levels are better when it comes to reducing the risk of heart attacks, strokes and congestive heart failure," says Roger S. Blumenthal, M.D., chair of the guideline writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. "We also know that bringing elevated lipids and blood pressure down in young adults supports optimal heart and vascular health throughout a person's life."
Why Earlier Screening Matters
The update arrives as research shows that about 1 in 4 adults in the United States has elevated LDL cholesterol (LDL-C), a major contributor to atherosclerosis (the narrowing or hardening of the arteries). When certain lipids build up, they can form plaque inside artery walls. This plaque can restrict blood flow, and under certain conditions, it may rupture and trigger a heart attack or stroke or require urgent medical treatment to restore circulation.
Despite these risks, the core advice for maintaining heart health remains unchanged. Experts continue to stress the importance of a balanced diet, regular physical activity, avoiding tobacco, getting enough sleep, and maintaining a healthy weight. According to Blumenthal, roughly 80% to 90% of cardiovascular disease is linked, at least in part, to factors people can modify, making lifestyle changes a critical first step.
Earlier Screening and Genetic Risk Factors
A key shift in the new guideline is the push for screening at younger ages and a broader look at personal risk. Doctors are encouraged to consider family history of atherosclerosis, underlying conditions such as rheumatoid arthritis, and life events like early menopause or pregnancy complications, including preeclampsia or gestational diabetes, when evaluating risk and planning treatment.
For instance, individuals with familial hypercholesterolemia, a genetic condition that causes very high LDL-C levels, should now begin screening earlier in life, starting around age 9 (or earlier). The guidance also recommends a one-time test for Lp(a), which is tied to inherited risk and can raise heart disease risk by about 40% at levels of 125 nanomoles per liter and double the risk at 250 nanomoles per liter.
New Risk Calculator Expands Long-Term Prediction
Another major update is the introduction of a new tool for estimating 10- and 30-year risk of heart attack and stroke. The previous model focused mainly on 10-year risk for adults age 40 and older and relied on basic factors such as age, cholesterol levels, and blood pressure.
The new calculator, Predicting Risk of Cardiovascular Disease EVENTs (PREVENT), includes additional measures such as blood sugar and kidney function. It is designed for use starting at age 30 and is based on data from 6.6 milli