New cholesterol guidelines push for earlier tests and personalised care

The latest cholesterol guidelines expand testing timelines and introduce new risk markers, helping doctors identify and manage heart disease risk earlier than before

For years, people considered cholesterol checks later in life, often after a warning sign appeared. However, new guidelines challenge that reactive approach by focusing on prevention much earlier. Experts now say that waiting until adulthood may miss critical windows for intervention. This change could reshape routine health check-ups across age groups. 

A group of 11 medical associations, including the American College of Cardiology and the American Heart Association, released the new guidelines to help doctors and patients manage cholesterol levels. 

“We’re trying to help clinicians and patients decide: When should medicine be considered?” said Dr Roger Blumenthal, the chair of the guideline writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore.

 

Earlier testing: A major shift

Heart disease remains one of the leading causes of death globally, and high levels of low-density lipoprotein (LDL), often called “bad cholesterol”, play a central role. However, earlier guidelines focused mainly on short-term risk, meaning many younger people slipped under the radar. The recommendations, published in the Journal of the American College of Cardiology, change that approach by prioritising lifetime risk and early intervention.

• Children aged 9–11 are now advised to undergo testing, mainly to detect inherited conditions
• Screening should resume in late adolescence and continue every five years in adulthood
• People with family history or risk factors may need testing even earlier

This marks a clear move away from the idea that cholesterol is only an adult problem. Experts say early detection can identify conditions, like familial hypercholesterolemia (an inherited condition causing very high “bad” cholesterol early in life), which often go unnoticed until complications arise. 

"Shifting the paradigm toward proactive prevention strategies earlier in life can meaningfully change the trajectory of cardiovascular disease and lead to better health outcomes for people decades later," says Seth Martin, cardiologist and member of the guideline writing committee.

A wider lens on cholesterol and heart health

Traditionally, cholesterol care centred around LDL levels alone. While LDL remains crucial, the new guideline expands the focus.

• Lipoprotein(a), a largely genetic risk factor, is now recommended to be checked at least once
• Additional markers like apolipoprotein B (ApoB), a protein linked to harmful blood fats, can help refine risk
• Imaging tools such as coronary artery calcium scans can guide treatment decisions

This broader approach allows doctors to identify hidden risks that standard tests may miss.

New risk calculator looks beyond 10 years

The guideline also introduces a new cardiovascular risk calculator called PREVENT (Predicting Risk of cardiovascular disease EVENTs). The new approach:

• Assesses the risk of heart attack and stroke over the next 10 and 30 years in adults aged 30–79 who do not have existing heart disease
• Considers multiple factors such as blood pressure, diabetes and smoking
• Helps identify younger individuals who may appear low-risk short-term but face high lifetime risk

This allows doctors to identify long-term risk earlier, even when short-term risk appears low. This change reflects a growing understanding that heart disease develops gradually over decades.

Cholesterol targets to be more personal

The guideline also reintroduces clear LDL targets, which vary depending on individual risk levels.

• Below 100 mg/dL for most people
• Below 70 mg/dL for those at higher risk
• Below 55 mg/dL for people with existing heart disease

Experts emphasise that “lower is better”, particularly for those with increased cardiovascular risk.

A shift towards prevention

Instead of waiting for cholesterol levels to rise or symptoms to appear, new guidelines focus on preventing damage before it begins.

• Earlier screening helps catch risk sooner
• Personalised tools guide timely treatment
• Lifestyle changes remain central, alongside medications when needed

This proactive approach could reduce long-term exposure to harmful cholesterol and lower the risk of heart attacks and strokes. 

For many people, these changes may mean getting tested earlier than expected and more regularly over time. It also highlights the importance of family history and genetic factors, which can influence risk even in otherwise healthy individuals. 

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This report is for informational purposes only and is not a substitute for professional medical advice.