The American College of Cardiology and the American Heart Association have just released fresh advice on checking and treating blood cholesterol. This is the first major update since 2018.
The new paper was shared at the 75th ACC Scientific Session in New Orleans and appeared in top medical journals.
What the update focuses on
The main goal is to bring down low‑density lipoprotein, or LDL, often called "bad" cholesterol. It also looks at other fats like lipoprotein(a) (Lp‑a). Doctors are urged to start testing earlier, especially for people whose families have heart problems.
Dr. Roger Blumenthal, who led the writing team, says that lower LDL levels keep hearts safer from attacks, strokes, and heart failure. He also notes that keeping cholesterol and blood pressure down in young adults helps protect the heart for life.
Why checking sooner matters
About one in four U.S. adults has high LDL, which can cause plaque to build up inside arteries. Plaque narrows the vessels and may burst, leading to a heart attack or stroke.
Even with this risk, the basics of heart health stay the same: eat a balanced diet, stay active, avoid tobacco, get enough sleep, and keep a healthy weight. Lifestyle choices affect up to 90 % of heart disease risk.
New factors for risk assessment
Doctors should now think about family history, conditions such as rheumatoid arthritis, and life events like early menopause, pre‑eclampsia, or gestational diabetes when judging risk.
People with familial hypercholesterolemia— a genetic disorder that makes LDL sky‑high—should begin testing around age 9. A one‑time Lp(a) test is also recommended because high levels raise heart‑disease risk sharply.
Better risk calculator
The updated guidelines introduce the PREVENT calculator. It predicts heart‑attack and stroke risk over 10 and 30 years for adults starting at age 30. Unlike the old tool, it adds blood‑sugar and kidney‑function numbers and is based on data from 6.6 million people.
Extra tests that can help
When risk is unclear, doctors may use extra checks called “risk enhancers.” These include a high‑sensitivity C‑reactive protein test for inflammation, an Lp(a) measurement, and detailed family‑history reviews. Imaging such as coronary‑artery calcium scans can also show hidden plaque.
New treatment targets
The guidance sets lower LDL goals. For people without heart disease, LDL should be under 100 mg/dL. Those at intermediate risk aim for below 70 mg/dL, and high‑risk patients should stay under 55 mg/dL. Targets for non‑HDL cholesterol and apolipoprotein B are also included.
Besides statins, the update lists other medicines—ezetimibe, bempedoic acid, and injectable PCSK9 inhibitors—for patients who need extra help lowering cholesterol.
Looking ahead
Experts think future versions may push LDL goals even lower, especially for people with moderate artery buildup. Ongoing studies support aggressive cholesterol‑lowering strategies.
The 2026 dyslipidemia guideline was created by the ACC, AHA, and many partner organizations dedicated to heart‑health prevention.