New Heart Guidelines Call for Lower Cholesterol Goals & Earlier Screening May 20, 2026 New national guidelines are urging doctors to start assessing heart disease risk earlier in life and to aim for lower cholesterol levels to help prevent heart attacks and strokes. The March 2026 American College of Cardiology and American Heart Association guidelines lower recommended targets for LDL cholesterol, often called “bad” cholesterol. For people at high risk of heart disease, doctors now recommend keeping LDL below 70 milligrams per deciliter. For people at very high risk, including those who have already had a heart attack or stroke, the new target is below 55 milligrams per deciliter. “The big shift is earlier and more aggressive prevention,” said Jeremy Warner, DO, a Samaritan Cardiology – Corvallis cardiologist who reviewed the updated guidance. “We are moving from reacting to heart disease to identifying risk much sooner and addressing it before an event happens.” Earlier Screening & Longer-term Risk Previous cholesterol guidelines focused on adults ages 40 to 75. The new recommendations expand routine risk assessment to adults ages 30 to 79 and call for cholesterol screening in children between ages 9 and 11. Doctors are also encouraged to use a new risk calculator that estimates a person’s chance of developing cardiovascular disease over both the next 10 years and the next 30 years. “That longer-term view helps us identify people who may not look high risk today, especially younger adults, but who have a much higher lifetime risk,” Dr. Warner said. Lifestyle changes remain the foundation of heart disease prevention. The guidelines continue to emphasize regular exercise, healthy eating, smoking cessation, weight management and limiting ultra processed foods. The difference, Dr. Warner said, is how early doctors are encouraged to look for hidden risk and consider additional tools or treatments when appropriate. Clearer Cholesterol Targets Instead of focusing only on lowering cholesterol by a certain percentage, the guidelines now set specific LDL goals based on overall risk. For people with known heart disease, the recommendation is clear: aim for LDL below 55 milligrams per deciliter. That is lower than the previous goal of under 70. For people without heart disease, LDL targets vary. Some groups have goals below 100, while others are advised to aim below 70, depending on family history, cholesterol levels and results from newer risk tests. New Emphasis on Lp(a) & Calcium Scoring The guidelines place greater emphasis on lipoprotein(a), known as Lp(a), a cholesterol-related particle that is not included in a standard cholesterol test. Lp(a) levels are genetically determined, meaning they are set at birth and not significantly changed by diet or exercise. This is different from a genetic test, which looks for a specific gene mutation. An Lp(a) blood test simply measures how much of this particle is in the blood. “Everyone should have Lp(a) checked once in adulthood,” Dr. Warner said. “If it’s elevated, first-degree family members should be tested too, because high levels often run in families.” Coronary artery calcium scoring, a CT scan that detects plaque in the heart arteries, is also highlighted as a decision-making tool for select patients. A score of zero may suggest lower risk, while higher scores can support starting medication sooner. The test is not recommended for everyone but can be helpful when treatment decisions are uncertain. Medications Still Play a Key Role Statins remain the first-choice medication for lowering LDL cholesterol. If statins are not tolerated or do not lower cholesterol enough, doctors may add other medications such as ezetimibe (Zetia) or newer injectable therapies like evolocumab (Repatha). “When we start cholesterol-lowering medication, it is often long-term, especially for people who have already had a heart event,” Dr. Warner said. “In primary prevention, the decision is more individualized, but risk usually increases with age.” Overall, the new guidelines reflect a more personalized approach to preventing heart disease, combining lifestyle habits with earlier screening and clearer treatment targets. “This is not about overtreating,” Dr. Warner said. “It’s about using better tools to understand risk and doing what’s needed, in addition to healthy living, to prevent heart problems over a lifetime.” At your next visit with your primary care provider, discuss your heart health and cholesterol screening. For more information about Samaritan’s heart program, see samhealth.org/Heart.
