Cholesterol Screening Recommendations Lowered to Age 30, Novel Guidelines Suggest
New cholesterol guidelines, published on March 13 in Circulation and the Journal of the American Heart Association, recommend that doctors commence screening and treating patients in their 30s – significantly earlier than previous recommendations. Here’s the first revision of the guidelines since 2018.
The American Heart Association estimates that roughly 25% of adults in the United States have high levels of low-density lipoprotein (LDL) cholesterol, a key risk factor for heart disease and stroke. These updated recommendations reflect a growing understanding of the importance of early intervention in preventing cardiovascular issues.
For patients in their 30s, doctors will now use a tool called PREVENT to assess their risk of developing atherosclerotic cardiovascular disease. This tool considers factors such as body mass index, cholesterol levels, and smoking habits to calculate a 10-year risk for individuals aged 30 to 79, and a 30-year risk for those aged 30 to 59.
The guidelines suggest that adults age 30 and older with an LDL level of 160 mg/dL or higher should be prescribed statins, a commonly prescribed medication. Potential side effects of statins include muscle pain, weakness, or liver damage, and initial lower doses are recommended for younger patients.
For most individuals without existing risk factors, the current goal is to maintain LDL levels below 100 mg/dL. Those at higher risk should aim for levels below 70 mg/dL, and patients with existing heart disease should strive for levels below 55 mg/dL, as these targets are associated with a reduced risk of heart attack and stroke.
The guidelines also recommend that once patients reach their LDL goals, they should be tested for apoB, a protein that attaches to harmful fat particles in the blood, including LDL. Prior guidelines did not routinely recommend apoB testing as part of standard cholesterol screening. ApoB testing can provide a clearer picture of risk for patients with high triglycerides, type 2 diabetes, or cardio-renal-metabolic syndrome.
the guidelines advise adults to undergo at least one Lp(a) test. Lp(a) is a type of cholesterol that standard tests don’t detect, and is estimated to affect 64 million Americans. Lp(a) levels are largely determined by genetics and are less influenced by diet or exercise. High Lp(a) levels are associated with an increased risk of cholesterol buildup in the arteries. A level above 250 nmol/L increases heart disease risk.
These updated guidelines underscore the importance of proactive cardiovascular health management and could lead to earlier interventions to reduce the burden of heart disease and stroke.
