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• Posted March 17, 2026

Cholesterol Needs Lifelong Management, New Heart Guidelines Say

TUESDAY, March 17, 2026 (HealthDay News) — Heart experts are calling for a full-court press against cholesterol, including lifelong screening and treatment, a set of new guidelines says.

Blood testing for cholesterol should start in childhood, and take place at least every five years to track each person’s heart health risk, the American College of Cardiology and the American Heart Association said in updated guidelines.

The idea is to take action as early in life as possible, because high cholesterol can start increasing a person’s heart disease risk even as a child or a teenager, experts said.

To that end, adults should be considered for a cholesterol-lowering statin drug in their 30s, if diet and exercise hasn’t brought their levels down and they are at elevated risk for heart problems, according to the guidelines.

“We know 80% or more of cardiovascular disease is preventable and elevated LDL cholesterol, sometimes referred to as ‘bad’ cholesterol, is a major part of that risk,” said Dr. Roger Blumenthal, chair of the guideline writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore.

“While we want to try to optimize healthy lifestyle habits as the first step to lower cholesterol, we realize that if lipid numbers aren’t within the desirable range after a period of lifestyle optimization, we should consider adding lipid-lowering medication earlier than we would have considered 10 years ago,” Blumenthal explained in a news release.

About 1 in 4 U.S. adults has high levels of “bad” LDL cholesterol, which increase risk of heart attack and stroke, experts said in background notes.

“The motto of the new guideline is 'Lower for longer is better'; essentially, a new more proactive approach to treating heart disease,” Dr. Eugenia Gianos, system director of cardiovascular prevention at Northwell Health in New York City, said in a statement.

“The release of these new guidelines is exceptionally important right now because it brings a spotlight back onto the importance of LDL cholesterol in the development of heart disease,” said Gianos, who was not involved in drafting the new guidelines. 

“Essentially, it is the biggest causal risk factor in heart disease, and we have the ability to reduce that risk by treating early and aggressively in the appropriate patients,” she added.

The guidelines call for giving 9- to 11-year-olds a blood test to see if they have genetically driven high cholesterol, also called familial hypercholesterolemia, a condition that requires lifetime treatment to lower heart risk.

Then, beginning at age 19 and at least every five years afterward, adults should undergo regular blood tests to monitor their cholesterol levels, under the guidelines.

People should have a “bad” LDL cholesterol level of no more than 100 mg/dL to prevent a first heart attack or stroke, according to the guidelines. People at higher risk should try to drive down that number to less than 70 mg/dL.

“In general, lower LDL is better, especially for people at increased risk for a heart attack or stroke,” Dr. Pamela Morris, vice-chair of the guideline writing committee, said in a news release. She’s chair of cardiovascular disease prevention at The Medical University of South Carolina in Charleston.

“Clinical trials have clearly demonstrated significant benefits for reduction in cardiovascular events when LDL-C levels are even lower than recommended in previous guidelines,” Morris said.

Earlier treatment should start with a good lifestyle — healthy weight, regular exercise, no tobacco, good sleep and a diet rich in vegetables, fruits, whole grains, beans, nuts, seeds, unsaturated fats and lean proteins, under the guidelines.

People should be prescribed a cholesterol-lowering drug if lifestyle changes fail to lower their levels, the guidelines said.

Adults also should have their lipoprotein(a) level checked at least once in adulthood, under the guidelines. It’s a type of LDL cholesterol that contains an added protein that makes clogged arteries more likely.

Lipoprotein(a) is genetically driven, and higher levels can as much as double a person’s heart attack or stroke risk, experts said. Lifestyle changes have minimal effect, so people with this type of cholesterol will need to take medications.

“Lipoprotein(a) is a unique type of cholesterol, different from the usual profile that is checked that is independently associated with heart disease and is often underrecognized,” Gianos said.

“It's often the cause of heart disease in many family members who all have heart disease,” she continued. “It's now recognized that it is elevated in about 1 in 5 people, and that if we recognized that earlier in life and treat cholesterol in general, we can reduce the risk of heart disease."

The new guidelines also recommend use of a new risk calculator for heart disease called PREVENT, which stands for Predicting Risk of Cardiovascular Disease EVENTs.

The PREVENT calculator is designed to track heart disease risk among people from age 30 to 79. The guidelines said it should be used in conjunction with blood testing to determine whether a person needs to change their lifestyle or go on meds to lower their cholesterol levels.

“With this new assessment tool, we can better estimate cardiovascular risk using health information already obtained during an annual physical — cholesterol, blood pressure readings and other personal information such as age and health habits — and then further personalize the risk score for each individual by looking at ‘risk enhancers,’ which can help guide the need for lipid-lowering therapy,” Blumenthal said.

Gianos, meanwhile, called the PREVENT calculator a step up from prior risk calculators.

“It uses things like ZIP code, for example, to differentiate risk that may be due to sociodemographic factors that are often not captured in other risk calculators,” she said. “It also uses things like kidney disease, sugar markers, and your body mass index.” (Body mass index is an estimate of body fat based on height and weight.)

The new guidelines appear in the Journal of the American College of Cardiology and the journal Circulation.

More information

The American Heart Association has a patient-friendly overview of the new cholesterol guidelines.

SOURCES: American Heart Association/American College of Cardiology, news release, March 13, 2026; Circulation, March 13, 2026; Dr. Eugenia Gianos, director of cardiovascular prevention, Northwell Health, New York City