WASHINGTON — A groundbreaking set of preventative screening recommendations has been introduced to tackle cholesterol concerns before they escalate into heart disease.

Unveiled on Friday by the American Heart Association, the American College of Cardiology, and other esteemed medical organizations, the guidance provides a detailed framework for assessing and managing blood lipids.

In the United States, approximately one-quarter of adults have elevated levels of low-density lipoprotein (LDL) cholesterol, commonly known as “bad” cholesterol, which is linked to heightened risks of heart attacks and strokes.

The report highlights that over 80% of cardiovascular diseases can be prevented, with high LDL levels being a significant factor in these risks. The new recommendations advocate for a more thorough approach than simply measuring LDL and triglycerides.

A key update is the introduction of a novel risk assessment tool, PREVENT-ASCVD, targeting adults aged 30 to 79. This modern calculator replaces the previous model, categorizing 10-year risk levels as low (under 3%), borderline (3–5%), intermediate (5–10%), or high (10% or more).

That calculation can be further refined by what the guidelines call “risk enhancers,” which are factors that could accelerate earlier or more aggressive treatment. 

Doctors are also encouraged to consider three additional tests to help screen for risk factors: 

• Selective use of a non-contrast artery calcium (CAC) scan
• Lipoprotein (a), or LP(a)
• Apolipoprotein B, or apoB 

The new guidelines encourage a wider use of the CAC scans, which are non-invasive and help measure calcified plaque buildup in a person’s arteries.  

The screening for lipoprotein(a), or LP(a), is a one-time blood test during adulthood that identifies a genetic risk marker for heart disease. Experts say the number is genetically determined and remains relatively stable during a person’s lifetime, so it’s unlikely a second test would be needed. Elevated levels help identify inherited risks for stroke, heart attack and other cardiovascular illnesses. 

The apolipoprotein B, or apoB, test helps identify residual risk for deposits on blood vessel walls. 

“Having healthy LDL-cholesterol levels or high-density lipoprotein-cholesterol (HDL-C), traditionally thought of as ‘good’ cholesterol, isn’t necessarily a ‘get out of jail free’ card,” said Dr. Roger Blumenthal, the chair of the guideline writing committee and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore. “Measuring other biomarkers can give a more complete picture of someone’s cardiovascular risk and help inform decisions about whether lipid-lowering therapy is needed sooner rather than later or if more intensive therapy is warranted.”

Click to learn more about the new guidelines.