Updated Guidelines for Managing Cholesterol in the US
Approximately one in four adults in the United States has high LDL cholesterol, which can accumulate in arteries and elevate the risk of heart attacks and strokes. However, it’s important to remember that high LDL isn’t the only concern when it comes to heart health.
Other lipids and lipoproteins can also reach abnormal levels in the bloodstream, leading to a condition known as dyslipidemia. This condition can contribute to atherosclerotic cardiovascular disease (ASCVD), which is a leading cause of death worldwide.
This year, experts in the US revised their guidelines on managing cholesterol and preventing dyslipidemia, significantly updating the previous recommendations from 2018. The new guidelines continue to emphasize cholesterol management but also take a broader view, encouraging earlier interventions to address unhealthy blood fat levels that can pose health risks.
“We know that over 80 percent of cardiovascular diseases are preventable, and high LDL cholesterol is a major contributor to these risks,” explains cardiologist Roger Blumenthal from the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.
“While promoting healthy lifestyle choices remains a priority, we also recognize the need to consider adding cholesterol-lowering medications sooner than we might have a decade ago if lifestyle changes don’t yield desired lipid levels.” The updated guidelines primarily urge healthcare providers to treat dyslipidemia earlier to minimize the long-term risks tied to harmful lipoproteins.
“Sustaining lower LDL cholesterol levels over time, similar to maintaining lower blood pressure, greatly reduces the risk of future heart attacks and strokes,” Blumenthal adds.
Under the new recommendations, cholesterol screenings are recommended for children ages 9 to 11, provided they haven’t been previously screened. In families with a history of serious cardiovascular disease or cholesterol issues, screening can start as early as age two.
Furthermore, doctors are encouraged to use a new risk calculator, called PREVENT, to estimate the risk of cardiovascular disease over the next 10 to 30 years for patients aged 30 to 79. This tool allows for better risk assessment using health data gathered during routine physical exams, including cholesterol and blood pressure readings, as well as personal health habits.
Based on the new calculations, doctors might consider LDL-lowering strategies—including lifestyle changes and medications like statins—for patients at borderline risk (3 to 5 percent chance) of developing ASCVD within the next decade, and even in cases considered to have intermediate risk (5 to 10 percent).
The guidelines also lay out new target levels for LDL cholesterol, with goals set at below 100 mg/dL for patients at borderline or intermediate risk, and below 70 mg/dL for those at high risk. For patients already diagnosed with ASCVD and considered very high risk, the target is under 55 mg/dL.
“Lowering LDL cholesterol is generally beneficial, especially for those at higher risk for heart attacks or strokes,” asserts cardiologist Pamela B. Morris from the Medical University of South Carolina. “Research has clearly shown that reducing LDL levels, even more than earlier recommendations suggested, can significantly decrease cardiovascular events.”
While statins remain the primary treatment for lowering LDL, the updated guidelines also address additional medications, such as ezetimibe, bempedoic acid, PCSK9 inhibitors, and inclisiran.
For patients, updated advice includes eating healthily, recognizing that lifestyle changes can effectively lower cholesterol levels, and being proactive about regular checkups. If someone’s ‘bad’ cholesterol continues to rise despite their best efforts, these new guidelines suggest that medical intervention may be necessary sooner rather than later.
The revised guidelines have been published in the Journal of the American College of Cardiology.
