The American College of Cardiology and American Heart Association have issued new guidelines on cholesterol screening and management, urging earlier testing and personalized risk assessments. The recommendations, presented on March 28 in New Orleans, emphasize lowering LDL cholesterol and incorporating genetic factors like lipoprotein(a). A new risk calculator aims to predict heart disease over longer periods.
The guidelines, the first update since 2018, were published in the Journal of the American College of Cardiology and Circulation. They were unveiled at the American College of Cardiology's 75th Annual Scientific Session in New Orleans. Roger S. Blumenthal, chair of the writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, stated, 'We know that lower LDL cholesterol levels are better when it comes to reducing the risk of heart attacks, strokes and congestive heart failure.' The guidance stresses lifestyle changes as the foundation, noting that 80% to 90% of cardiovascular disease links to modifiable factors like diet, exercise, and weight control. About one in four U.S. adults has elevated LDL cholesterol, which contributes to atherosclerosis and potential heart events. Doctors are now advised to screen earlier, such as from age 9 for those with familial hypercholesterolemia, and perform a one-time Lp(a) test, which elevates risk by 40% at certain levels. The new PREVENT calculator estimates 10- and 30-year risks starting at age 30, drawing from data on 6.6 million people and including kidney function and blood sugar. Seth Martin, a cardiologist on the committee, said, 'Shifting the paradigm toward proactive prevention strategies earlier in life can meaningfully change the trajectory of cardiovascular disease.' For treatment, optimal LDL targets range from below 100 mg/dL for low-risk individuals to under 55 mg/dL for high-risk ones, with options like statins, ezetimibe, and PCSK9 inhibitors. Risk enhancers such as coronary artery calcium scans and inflammation markers help tailor plans.
