What The New Cholesterol Guidelines Mean For You

Sometimes, when new health guidelines come out, it’s just a case of a government saying “you should do more/less of these things you’re already doing/avoiding”.

This isn’t one of those occasions:

Knowledge is power health

New cholesterol management guidelines from the American College of Cardiology and American Heart Association have been released for the first time since 2018, and have been published in the Journal of the American College of Cardiology and Circulation.

The shortest version is: test everything, earlier and oftener

What’s mostly the same:

• Enjoying heart-healthy diet, regular physical activity, avoiding tobacco, getting good sleep, and maintaining a healthy weight remain the foundation, with 80%–90% of cardiovascular disease linked to modifiable risk factors.
• In particular, the guide still emphasizes lowering LDL cholesterol and other lipids like lipoprotein(a) to reduce risks of heart attack, stroke, heart failure, and cardiovascular disease in general.

What’s new:

• It recommends more individualized risk assessment using medical history, including conditions like rheumatoid arthritis, and life factors such as early menopause or pregnancy complications.
• It includes tailored advice for anyone who is pregnant or lactating, people over the age of 75, and people with conditions like diabetes, chronic kidney disease, HIV, or cancer.
• It recommends a one-time test for Lp(a), as elevated levels can raise heart disease risk by about 40% at 125 nmol/L and double it at 250 nmol/L.
• It also recommends monitoring C-reactive protein (CRP) levels in general, and high-sensitivity C-reactive protein (hsCRP) in particular.
  • If you’re curious about this, we wrote about it here: Demystifying C-Reactive Protein (CRP)!
• It recommends more frequent coronary artery calcium scans to detect plaque and refine treatment decisions.
• It recommends earlier cholesterol screening, especially for people with a family history of cardiovascular disease or inherited condition.
  • See also: Demystifying Cholesterol
• It also recommends that people with familial hypercholesterolemia should begin screening around age 9 or earlier.
• It has a new risk calculator; the PREVENT tool replaces older models, using much broader data (6.6 million people), and incorporating blood sugar and kidney health to estimate 10- and 30-year cardiovascular risk, starting from age 30.

On the topic of those cholesterol tests, you might be wondering about the targets, so…

LDL cholesterol goals are:

• <100 mg/dL for people in the “low risk” category based on other factors
• <70 mg/dL for people in the “intermediate risk” category based on other factors
• <55 mg/dL for people in the “high risk” category based on other factors

You can read the new guidelines for yourself, here: 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

That sure is a lot of institutions that were involved in this and signed off on it, isn’t it?

If you’d like to get a head start on the tests, then check out: 6 Blood Markers That Predict Disease Years Before Symptoms Appear

And if you’d like to just directly get started on lowering your cholesterol levels, then we have you covered for that, too:

• Statins: His & Hers?
• Lower Cholesterol Naturally
• Take These To Lower Cholesterol! (Statin Alternatives)
• How To Lower Your Cholesterol By 50+ Points Without Drugs
• What Two Days Of Oats Will Do To Your Lipids

Want to learn more?

For a much deeper dive than we have room for here, you might want to consider this book we reviewed a while back:

Prevent & Reverse Heart Disease – by Dr. Caldwell Esselstyn

Take care!