What to Know About the New Cholesterol Guidelines

Contributor: Romit Bhattacharya, MD

Apr 10, 2026

8 minute read

A mom and young son smile at each other as they place paper bags full of healthy groceries on the kitchen counter.

High levels of cholesterol and other lipids—forms of fat that circulate in the blood—are on the rise. One in 4 adults in the U.S. now has high low-density lipoprotein (LDL) cholesterol, often called “bad cholesterol,” that increases risk of heart attack and stroke.

The American Heart Association (AHA), American College of Cardiology (ACC), and other medical groups recently released new guidelines for how doctors manage cholesterol. They focus on controlling those levels earlier and understanding a person’s lifetime risk of heart disease.

“One of the biggest takeaways is what people can do at younger ages to prevent heart disease before it happens,” says Romit Bhattacharya, MD, a general and preventive cardiologist with the Mass General Brigham Heart and Vascular Institute. “Not only the lifestyle changes you can make to keep cholesterol levels low, but also working with your provider to understand your individual risk.”

Dr. Bhattacharya shares an overview of the new cholesterol guidelines and breaks down the important takeaways to help you and your provider keep your heart healthy.

New cholesterol guidelines: Key takeaways and why they matter

The new guidelines are the first update in nearly 10 years to how doctors manage high cholesterol. But why is that so important?

Your body needs lipids like cholesterol and triglycerides to function, but having too much can cause heart problems. These lipids can cause fatty deposits, or plaque, to build up in your arteries. The plaque can harden the arteries over time, leading to a condition called arteriosclerosis. This restricts blood flow and can cause heart disease, heart attack, stroke, and other problems.

The new guidelines share lifestyle changes, screenings, and treatment that help keep lipid levels under control and prevent those problems from happening. The authors, including Ron Blankstein, MD, a Mass General Brigham preventive cardiologist, wrote the guidelines after reviewing years of research and advances in screening to help improve heart health across the country.

Key takeaways from the guidelines include:

Healthy lifestyle changes to reduce heart disease risk. Certain healthy habits can help maintain your heart health and prevent high cholesterol throughout your lifetime.
Assess heart disease risk earlier and more accurately. A new calculator tool helps doctors estimate a person's risk of heart attack or stroke starting at age 30—earlier than before—and identify who may benefit from treatment sooner. They also recommend new screening tests to assess overall risk and guide treatment if needed, including cholesterol screening in children aged 9 to 11.
Goals for certain cholesterol levels. The guidelines recommend specific goals for some cholesterol levels depending on a person’s risk of heart disease.

Healthy lifestyle changes for heart disease prevention

The new cholesterol guidelines focus on preventing heart disease and related problems before they have a chance to develop. “One of the best ways you can do this is through lifestyle changes—and the earlier you can start, the better,” says Dr. Bhattacharya. “Even small changes over time can make a big difference.”

The guidelines recommend you:

Eat a heart-healthy diet. Aim for foods that lower cholesterol, such as fruits, vegetables, nuts, legumes, whole grains, and fiber.
Exercise regularly, like walking or strength training.
Maintain a healthy weight. Talk to your provider about how diet and regular physical activity may help you get to a healthy weight. You may also discuss if obesity medication is right for you.
Avoid tobacco products. Get tips to quit smoking or vaping.
Prioritize healthy sleep habits. Sleep affects heart health, and certain habits like keeping a routine and avoiding screens just before bed can help you sleep better.
Manage your stress. Researchers have linked stress to heart disease risk. Different stress management techniques, like meditation or cognitive behavioral therapy, can help reduce how it affects your health.
Work with your provider on cholesterol-lowering medication if lifestyle changes aren't enough on their own. Statins and newer therapies can significantly reduce heart disease risk for the right patients.

The best time to start thinking about heart disease prevention is before you have any symptoms—and these guidelines help make that possible at a younger age than ever before.

Romit Bhattacharya, MD
Cardiologist
Mass General Brigham Heart and Vascular Institute

Understanding long-term heart disease risk

Providers are now able to better understand a person’s lifetime risk of heart disease. They use a new risk score tool and additional screening tests to know if someone needs treatment earlier to help prevent problems before they happen.

PREVENT heart disease risk calculator

The guidelines recommend providers use a new risk calculator, called PREVENT, for adults aged 30 to 79 years old.

This tool uses information readily available from a routine checkup—such as your blood pressure, cholesterol levels, kidney function, and blood sugar—to estimate your 10-year risk of heart attack or stroke. It can also project that risk out over 30 years. Your provider may recommend earlier treatment to lower your lipid levels if you’re at higher risk. PREVENT replaces an older calculator that overestimated risk for many patients, meaning it recommended treatment for some patients who didn’t need it, while others at genuine risk were missed.

While lifestyle plays a role, certain people may be at higher risk of heart disease. The guidelines now formally recognize the following as risk factors your provider should consider:

High blood pressure (hypertension)
High blood sugar (prediabetes or type 2 diabetes)
Family history of early heart disease (in a parent or sibling before age 55 in men, or age 65 in women)
Overweight or obesity
Chronic inflammatory conditions, like lupus or rheumatoid arthritis
Early menopause (before age 45)
Preeclampsia
Diabetes in pregnancy (gestational diabetes)
High lipoprotein(a) levels (a type of cholesterol particle)
High polygenic risk score, if tested (a measure of inherited genetic risk for heart disease)
South Asian or Filipino ancestry, which carries higher heart disease risk

Updated lipid screening guidelines and other tests

Screening tests help your provider understand your overall risk of heart disease. You likely get a blood test at every annual physical that measures your lipid levels, including cholesterol and triglyceride levels.

The guidelines now recommend earlier cholesterol screening and additional tests for some people. The updates include:

Cholesterol screening in children. High cholesterol can affect heart disease risk even at younger ages, and children may be born with certain conditions that cause high cholesterol. The guidelines now recommend children aged 9 to 11 years have a cholesterol screening test to understand their heart disease risk early.
Lipoprotein(a) test for everyone at least once. Lipoprotein(a), or Lp(a), is a type of cholesterol particle that’s like LDL "bad cholesterol," but with an extra protein attached that makes it more harmful at high levels. Having high levels of Lp(a) contributes to plaque buildup in your arteries and heart disease risk. Unlike most cholesterol levels, which respond to diet and exercise, Lp(a) is almost entirely based on your genetics, so you only need to get this simple blood test once as an adult.
Apolipoprotein B test in certain people. Apolipoprotein B, or ApoB, is a protein found on the surface of cholesterol particles, including LDL, that directly drives plaque buildup in the arteries. LDL cholesterol measures the amount of cholesterol carried in those particles, while ApoB counts the number of harmful particles themselves. ApoB can be a more accurate picture of risk in some people, so your provider may check your ApoB level if you have high triglycerides, type 2 diabetes, obesity, or kidney disease. In these conditions, LDL alone can underestimate how much heart disease risk you actually carry.
Coronary artery calcium (CAC) scan for certain people. A CAC scan is a quick, low-radiation CT scan that detects calcium deposits in the walls of your heart's arteries. The deposits are an early sign of plaque buildup, often before you have any symptoms. The result of your scan is a score, and higher scores indicate more buildup and higher risk. A change in the new guidelines is that your CAC score can now determine your cholesterol treatment target, where a higher score means a lower LDL goal. Providers may use a CAC scan to decide if you should start medication if you’re in the intermediate risk range.

New target LDL levels

The new cholesterol guidelines include ideal levels of LDL cholesterol to aim for, depending on your individual risk of heart disease. These include:

100 mg/dL for people at borderline or intermediate risk who are starting cholesterol-lowering treatment
70 mg/dL for people at high risk, including those with a CAC score of 100 or higher
55 mg/dL for people at very high risk—including those who have already had a heart attack or stroke, or those with an extremely high CAC score (1,000 or above)

Talk to your doctor about the new cholesterol guidelines

Dr. Bhattacharya recommends speaking with your primary care provider (PCP) or cardiologist about the new guidelines.

“There’s a lot of great information in the guidelines, but your provider can help explain what they mean for you and your family specifically,” he says. “You can discuss if additional tests or treatments make sense depending on your risk. The best time to start thinking about heart disease prevention is before you have any symptoms—and these guidelines help make that possible at a younger age than ever before.”

Your provider may recommend treatments to lower your LDL cholesterol or other lipid levels sooner to get well ahead of any problems. They may recommend lifestyle changes, taking statin medication, or other therapies.

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Romit Bhattacharya, MD

Cardiologist