New Guidelines Emphasize Early Screening, Treatment

• The American College of Cardiology (ACC), the American Heart Association (AHA), and nine other leading medical organizations have issued new guidelines for the management of dyslipidemia.
• Dyslipidemia is abnormal levels of various lipids and lipoproteins in the blood, including cholesterol and triglycerides.
• The new guidelines replace the 2018 AHA/ACC Guidelines on the Management of Blood Cholesterol.
• A key update is the focus on the AHA PREVENT-ASCVD equations.

The American College of Cardiology (ACC), the American Heart Association (AHA), and nine other leading medical organizations recently released the new guidelines for treating and managing dyslipidemia.

The updated guidelines reflect the evolving understanding of the risk of atherosclerotic cardiovascular disease (ASCVD) associated with atherogenic lipoproteins beyond low-density lipoprotein cholesterol (LDL-C). This includes triglyceride-rich remnant particles and lipoprotein(a) [Lp(a)].

“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,” Roger Blumenthal, MD, chair of the guideline writing committee, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, and the Kenneth J. Pollin professor of cardiology at Johns Hopkins Hospital in Baltimore, MD, said in a press release.

“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. And lower LDL cholesterol for longer, just like lower blood pressure for longer, results in much greater protection against future heart attack and stroke risk,” Pollin continued.

“It’s important to pay attention to lipids because they can provide clues about what’s happening metabolically in the body,” Jack Wolfson, DO, a cardiologist and founder of Natural Heart Doctor, told Healthline. Wolfson wasn’t involved in the new guidelines.

The updated cholesterol guidelines consolidate evidence-based recommendations into a single document, offering comprehensive guidance on assessing and treating various blood lipids. This can effectively lower a person’s risk of developing ASCVD.

ASCVD results from the buildup of fatty deposits in the arteries and is a leading cause of death globally.

“[These] reinforce what we already know — the longer your LDL is higher, the greater your risk of atherosclerotic heart disease,” said Karishma Patwa, MD, a board certified cardiologist at Manhattan Cardiology in NYC. Patwa wasn’t involved in the new guidelines.

“While the targets for LDL are essentially the same, an emphasis is being placed on early detection of hyperlipidemia,” she told Healthline.

The updated guidelines emphasize early intervention through lifestyle changes, such as:

The guidelines also reinforce lower LDL-C goals and reduction based on individual risk to reduce lifetime exposure to unhealthy lipids and the risk of heart attack and stroke.

“Bringing back LDL targets is a meaningful shift,” said Rigved Tadwalkar, MD, consultative cardiologist and director of Digital Transformation Pacific Heart Institute in Santa Monica, CA. Tadwalkar wasn’t involved in the guidelines.

“It gives both clinicians and patients something concrete to aim for, which makes treatment decisions much more actionable,” he told Healthline.

These are newer and more contemporary cardiovascular disease risk calculators. They are now recommended for the primary prevention of ASCVD.

The PREVENT-ASCVD equations are designed for people ages 30 to 79 with no known ASCVD or subclinical atherosclerosis, and with specific LDL levels.

They are for estimating a person’s 10– and 30–year risk of heart attack and stroke. They can also help guide lipid-lowering therapy.

“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 in a press release.

The new guideline recommends that healthcare professionals consider additional tests when needed to improve cardiovascular risk assessment.

Further testing can also help to assess whether more intensive LDL-C lowering and management of other risk factors may be needed.

• Selective use of a non-contrast coronary artery calcium (CAC) scan: This can be used to check for early signs of calcium and plaque buildup in the heart arteries. Knowing a person’s CAC score may help with the decision of whether to prescribe statins.
• Lipoprotein (a): This should be measured at least once in adulthood. These levels are mostly genetically determined and remain relatively stable over a lifetime.
• Apolipoprotein B (apoB): This can be used to assess any residual ASCVD risk. Measuring apoB can also help guide treatment among people with cardiovascular-kidney-metabolic syndrome, type 2 diabetes, high triglycerides or known cardiovascular disease who have reached their LDL-C and non-HDL-C goals.

If LDL-C levels are not adequately lowered by lifestyle habits and statin therapy, the guidelines recommend the addition of non-statin therapies.

“We are moving beyond a one-size-fits-all model and starting to integrate multiple layers of risk, including clinical factors, imaging, and biomarkers, to better understand who is truly at risk,” said Tadwalkar.

“Overall, it reflects where the field is heading — earlier intervention, better risk stratification, and a more personalized but still structured approach to preventing cardiovascular disease.”