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# What to Know About the New Heart Disease Guidelines

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## Jeffrey Kluger


Editor at Large

Mar 18, 2026 7:10 PM UTC

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## Jeffrey Kluger


Editor at Large

Mar 18, 2026 7:10 PM UTC

Most people think of [high cholesterol](https://time.com/6248034/how-to-control-high-cholesterol/) as a condition of middle age. But you’re never too young to [start caring about your numbers](https://time.com/7361499/heart-risk-prevent-calculator/), and a sweeping [new set of heart-health guidelines](https://www.jacc.org/doi/10.1016/j.jacc.2025.11.016) published March 13 by a group of professional organizations in the _Journal of the American College of Cardiology_ affirms that. According to the new recommendations, qualifying patients might best begin taking cholesterol-lowering [statins](https://time.com/6250225/statins-risks-cholesterol/) as early as age 30\. What’s more, children should begin cholesterol screening in the age 9 to 11 group.


“The longer an individual’s arteries are exposed to plaque-causing [lipoproteins](https://time.com/7287371/what-is-lipoprotein-lpa-cholesterol/), the greater the long-term risk,” says Dr. Pamela Bowe Morris, professor of medicine at the Medical University of South Carolina and the vice chair of the guidelines-writing committee. “The earlier you intervene, the more you bend the curve and delay the onset of [atherosclerosis or plaque](https://time.com/7316703/heart-health-at-every-decade/).”

The new guidelines aim to give doctors and their patients an individualized and clear path to follow. Heart disease remains the leading cause of death worldwide, [according to the World Health Organization](https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death), accounting for 13% of global mortality. [Up to 90%](https://newsroom.clevelandclinic.org/2021/09/29/90-percent-of-heart-disease-is-preventable-through-healthier-diet-regular-exercise-and-not-smoking) of cardiovascular disease is preventable through medication and such lifestyle factors as exercise, diet, and smoking cessation. The new guidelines, which took 20 months to draft and relied on a dataset of nearly 6.5 million people, were drawn up by a committee representing 11 organizations including the [American Heart Association](https://www.heart.org/en/honor-memorial?s%5Fsrc=26I511AEMG&s%5Fsubsrc=fy26%5Fsem%5Fgoogle&utm%5Fsource=google&utm%5Fmedium=cpc&utm%5Fcontent=honormemorial&utm%5Fcampaign=dr%5Ffy26%5Fhonor%5Fmemorial&utm%5Fcontent=honormemorial&nbt=nb%3Aadwords%3Ax%3A21491133816%3A%3A&gad%5Fsource=1&gad%5Fcampaignid=23032286639&gbraid=0AAAAADfYbP52MXiWSGSJHQ2s6UkldWwX9&gclid=Cj0KCQjwmunNBhDbARIsAOndKplLVsZdGDX5uq94UYz%5FjnigpglmllxGBrstHdHmUeG0R7iktlprMXoaAiM0EALw%5FwcB), the [American College of Cardiology](https://www.acc.org/), and the [American College of Preventive Medicine](https://acpm.org/). The last such report was drawn up in 2018, and the field has advanced quickly in that time.


“There has been a wealth of science in the past eight years that impacts how we manage high cholesterol, what drugs we use \[and\] what patient populations might be at risk,” says Morris.

## A new way for doctors to determine your cholesterol risk

The new guidelines focus on people’s risk for dyslipidemia, a condition of abnormally high levels of blood lipids including triglycerides and low density lipoprotein (LDL), or “bad” cholesterol. They divide populations into four risk groups: low, borderline, intermediate, and high. Low-risk people have less than a 3% chance of developing cardiovascular disease over a 10-year time horizon; for borderline, it’s 3% to 5%; intermediate is 5% to less than 10%; and high is 10% or above. Several health and demographic conditions can influence the onset of cardiovascular disease and contribute to high LDL. So-called risk enhancers include a family history of heart disease; inflammatory conditions such as lupus or rheumatoid arthritis; obesity; HIV; reproductive conditions such as early menopause, preeclampsia, and gestational diabetes; and South Asian or Filipino ancestry.

Triglycerides and LDL aren’t the only blood markers that can spell danger. Also worrisome are proteins known as lipoprotein(a), or Lp(a); apolipoprotein B, or apoB; and high-sensitivity C-reactive protein, or hsCRP. Together, the three indicate a higher risk of inflammation, blood clotting, and plaque buildup. Statins can help lower apoB and hsCRC, [but not Lp(a)](https://griffinconciergemedical.com/blog/optimal-heart-labs-apob-lpa-cardiac-biomarkers-guide/). Diet, which can cause or exacerbate most forms of dyslipidemia, does not play a meaningful role in Lp(a) formation or reduction.

“Lipoprotein(a) is an inherited form of lipoprotein,” says Morris. “Your levels are determined by your genetics; you don’t have to do anything naughty to get it.” Diet and similar lifestyle interventions, however, do reduce other factors that can drive bad blood markers still higher.

The new guidelines recommend strict LDL thresholds for people depending on their risk group. [LDL readings of 160 to 189](https://my.clevelandclinic.org/health/articles/11920-cholesterol-numbers-what-do-they-mean) are considered high. People whose medical history, demographic group, and blood chemistry put them in the medium or borderline group should aim for an LDL of 100 or less. High risk individuals should shoot for 70 or less, and for those at very high risk, the goal is 55 or less.


Only a doctor can best determine the risk category to which any one patient belongs, but the authors of the paper also provide an [online risk calculator](https://professional.heart.org/en/guidelines-and-statements/prevent-calculator) known as PREVENT, for Predicting Risk of Cardiovascular Disease Events. The tool factors together age, gender, cholesterol, smoking habits, diabetes, weight and more to produce at least a rough idea of your 10-year cardiovascular disease risk.

“With this new assessment tool we can better estimate cardiovascular risk using health information already obtained during an annual physical,” said Dr. Roger Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, and chair of the guideline drafting committee, in a [statement](https://www.acc.org/About-ACC/Press-Releases/2026/03/13/18/01/ACCAHA-Issue-Updated-Guideline-for-Managing-Lipids-Cholesterol) that accompanied the release of the paper. “\[We can\] then further personalize the risk score for each individual by looking at risk enhancers which can help guide the need for lipid-lowering therapy.”


The simplest of those therapies are found in the American Heart Association’s [“Life’s Essential Eight”](https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8) checklist for reducing cardiac risk. Among the items on the list are diet, exercise, quitting (or never starting) smoking, getting adequate sleep, and managing weight, blood sugar, and blood pressure. The last item—managing cholesterol—is very patient-specific.

Depending on how high LDL levels are, many doctors will start patients on the AHA checklist items before turning to cholesterol-lowering statins. But if those methods don’t succeed or if LDL levels are particularly elevated, statins are the go-to. It’s the longer term risk of leaving the condition untreated for too many years that is behind the new recommendations for starting statins at age 30 for people at higher risk.

“The \[new\] risk equations are much more precise and much more accurate,” says Morris. “We are now able to predict risks in individuals as low as 30 and predict their long-term risk \[up to 30 years in the future\].”


Added Blumenthal in a statement: “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 10 years ago. \[L\]ower LDL for longer…results in much greater protection against future heart attack and stroke risk.”

## Why kids as young as 9 should get cholesterol screening

When it comes to kids, the idea of LDL screening as young as age nine is actually not all that new. According to Morris, as long ago as 2011, the recommendation was to begin checking cholesterol levels in the preteen years, but most parents and doctors were not heeding that advice.

“We are re-emphasizing that because the uptake on it has been dismal,” she says. “The reason is so that you can intervene early with lifestyle factors, and in addition identify those children with potential genetic lipid disorders.”


Heart disease can be for keeps. The blood chemistry that contributes to it doesn’t have to be. The new guidelines represent the most evidence-backed ways to stave off issues now and down the line.

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