New heart health recommendations emphasize early testing and treatment to lower cholesterol levels as key to reducing the risk of cardiovascular disease.

A group of 11 medical associations including the American College of Cardiology and the American Heart Association released new guidelines on March 13 to help doctors and their patients manage cholesterol levels. The recommendations advise first testing cholesterol in childhood, around age 10, with the aim of helping patients keep levels low, reducing the chances a heart attack or a stroke might happen decades in the future. Also new is a cardiovascular risk calculator called PREVENT that is designed to assess heart attack and stroke risk over the next 10 and 30 years in adults 30-79 years old who don’t already have heart disease.

The previous recommendations, released in 2018, relied on another calculator that was based on clinical data from a cohort of around 25,000 adults who participated in U.S. National Institutes of Health-sponsored studies, says Roger Blumenthal, a cardiologist at Johns Hopkins School of Medicine. That calculator looked forward just 10 years. What’s more, the guidelines did not have specific cholesterol benchmarks for people with different levels of risk based on family or medical history.

PREVENT, on the other hand, is based on studies that included a total of 6.6 million people, helping to better estimate short- and long-term risks on an individual basis, Blumenthal says. The new guidance also emphasizes additional tests that are not part of the standard cholesterol blood test, or lipid panel, including a one-time assessment of lipoprotein(a), or Lp(a). Levels of Lp(a) are determined by genetics and can increase the long-term risk of heart attack or stroke.

Roughly a quarter of U.S. adults have high levels of low-density lipoprotein, or LDL, cholesterol. Reducing these “bad” cholesterol levels with lifestyle changes such as healthy eating and exercise or with medications can lower the risk of cardiovascular disease, the leading cause of death globally.

Science News spoke with Blumenthal, who chaired the guideline writing committee, to learn more about the new recommendations and how the shifts might impact treatment. This conversation has been edited for length and clarity.

SN: What are the most important changes in the guidelines? 

Blumenthal: I’ll start with number one, which essentially is to assess and treat early. We recommended — especially if there’s any family history of heart disease, or if there’s another cardiovascular risk factor — that the clinician should screen with a lipid panel around age 10 and again around age 20 and then every five years after that.

We also made the point that, especially if you’re age 30 and above and your LDL cholesterol is 160 or higher on successive occasions, it certainly makes sense to consider starting a cholesterol-lowering medication if there’s a family history of heart disease or other risk factors.

We now have a more robust and more accurate risk estimator that we call PREVENT. I think one of the best things about PREVENT is that we have a good way to estimate long-term risk. We can tell [patients with certain risk factors] that while their risk over the next 10 years is really low, their risk over the next 20 to 30 years is quite high.

If there’s a family history of cardiovascular disease, even if your estimated risk in your 30s is quite low, clinicians should talk to their patients about [healthy lifestyle habits]. Many young adults in their 30s and 40s have a very low 10-year risk because so much of the PREVENT score is based on chronological age rather than biologic age. But we can now estimate 30-year risk. If you have a person in front of you who it says the [10-year] risk is one or two or three percent, but [the calculator can] tell them that if you don’t change your lifestyle habits, if you don’t improve your weight, your cholesterol, your blood pressure, your 30-year risk may very well be 30 percent, that gets their attention.