Unhealthy levels of cholesterol have long been viewed as a condition that primarily affects older adults. But new guidelines released by the American College of Cardiology (ACC) and the American Heart Association (AHA) are reshaping that perception — and highlighting a critical need for earlier testing and treatment, especially among younger adults.

With nearly 1 in 4 U.S. adults living with elevated low-density lipoprotein (LDL) cholesterol — often referred to as “bad cholesterol” — experts say the time to act is not later in life, but much earlier.

A Shift Toward Earlier Intervention

The updated guidelines on dyslipidemia emphasize a proactive approach: identifying and managing cholesterol levels before long-term damage occurs. Dyslipidemia is an imbalance of lipids (fats) in the blood—specifically high LDL ("bad") cholesterol, low HDL ("good") cholesterol, high triglycerides, or a high lipoprotein (a).

Heather Johnson, M.D., director of preventive cardiology for women's services with Baptist Health Heart & Vascular Care at the Christine E. Lynn Women's Health & Wellness Institute, and clinical affiliate associate professor for Florida Atlantic University, served on the leadership board and writing committee of the Dyslipidemia Guideline , which was composed of representatives from the ACC, the AHA and nine other leading medical associations. 

“The writing committee's goal was to develop guidelines that are both timely, based upon the latest evidence and practical for the clinician,” says Dr. Johson. “They reflect what we now understand much better than we did years ago: we need to treat dyslipidemia (cholesterol disorders) earlier. Waiting for someone to develop heart disease can mean we missed an earlier chance to prevent it.”

Creating Treatment Strategies Sooner

The new guidance reinforces that lowering LDL cholesterol earlier—and keeping it low over time—significantly reduces the risk of heart attack and stroke later in life.

“The main takeaway is that dyslipidemia abnormalities should be identified and addressed earlier, with an individualized treatment plan, not just after heart disease develops,” Dr. Johnson adds. “These guidelines give patients and clinicians the evidence-based tools to identify ASCVD risk sooner and take action sooner.”

Tom C. Nguyen, M.D., FACS, FAC,System chief executive, Baptist Health Heart & Vascular Care; chief medical executive, Baptist Health Miami Cardiac & Vascular Institute; director of minimally invasive surgery; Barry T. Katzen Endowed Chair, Baptist Health Miami Cardiac & Vascular Institute; chair and professor, Department of Cardiovascular Sciences, Florida International University Herbert Wertheim College of Medicine

“The newly released ACC/AHA guidelines offer a more comprehensive approach to reducing the risk of heart disease and stroke, from lifestyle changes to clearer cholesterol targets and treatment strategies,” explains Dr. Nguyen, who is also professor and chair of the Department of Cardiovascular Sciences at Florida International University Herbert Wertheim College of Medicine. “They also introduce the PREVENT risk calculator, helping clinicians assess and manage cardiovascular risk earlier and more precisely.”

Dr. Nguyen adds his congratulations to Dr. Johnson, who served on the writing committee and represented Baptist Health Heart & Vascular Care alongside national leaders in cardiology. “Her work reflects our ongoing commitment to advancing evidence-based care and improving outcomes for the patients and communities we serve,” said Dr. Nguyen.

Why Younger Adults Are at Risk

Younger adults may assume they are protected from heart disease due to their age, but that assumption can be misleading. Lifestyle factors such as poor diet, sedentary behavior, stress and lack of sleep—as well as genetic predisposition—can contribute to elevated cholesterol levels even in people in their 20s and 30s.

Dr. Johnson adds that high cholesterol is only one part of a broader issue. “High cholesterol is one part of dyslipidemia, but dyslipidemia is the broader term because it includes several types of abnormal blood fats that can raise the risk of heart attack and stroke,” she says.

A More Personalized Risk Assessment

One of the most significant updates in the new guidelines is the introduction of the PREVENT risk calculator. This tool estimates both 10- and 30-year risk of cardiovascular events in adults ages 30 to 79, allowing clinicians to tailor treatment more precisely.

“This matters because cardiovascular disease risk assessment calculators help to guide real-world treatment decisions,” Dr. Johnson says. “The goal is earlier LDL-C reduction for heart disease prevention.”

She notes that the new tool supports more individualized care.

“For readers, that means a more individualized conversation: not just ‘What is your cholesterol number?’ but ‘What is your overall risk, and should we act earlier to lower it?’” she explains.

Beyond Traditional Cholesterol Numbers

The updated guidelines also emphasize looking beyond standard cholesterol tests. Additional biomarkers—such as lipoprotein(a) [Lp(a)], apolipoprotein B (apoB), high-sensitivity C-reactive protein (hsCRP) and triglycerides—can provide a more complete picture of cardiovascular risk.

“These tests help us look beyond a standard cholesterol panel,” Dr. Johnson said. “A coronary artery calcium, or CAC, scan is a quick, non-contrast CT scan that looks for hardened plaque in the arteries of the heart; it can show whether advanced atherosclerosis is already present even before symptoms develop.”

She adds that other markers can reveal hidden risks.

“Lipoprotein(a), or Lp(a), is an LDL cholesterol-related particle that is largely inherited; high levels can raise heart disease, valve disease and stroke risk even if routine cholesterol numbers do not look dramatic,” she says.

Lower Targets, Stronger Protection

Another key change in the guidelines is the recommendation for lower LDL cholesterol targets based on an individual’s risk level. For many patients, especially those at higher risk, the goal is now significantly lower than in previous guidelines.

The emphasis is on reducing lifetime exposure to unhealthy cholesterol levels—something that is particularly important for younger adults who have decades of risk ahead.

When Lifestyle Changes Aren’t Enough

Lifestyle changes remain the foundation of cholesterol management. Maintaining a healthy weight, exercising regularly, avoiding tobacco, eating a heart-healthy diet and prioritizing sleep are all critical steps.

“The biggest message is that small, consistent habits matter,” Dr. Johnson says. “I encourage patients to start with the basics: build meals around vegetables, fruit, whole grains, healthy carbohydrates, and lean proteins.”

She emphasizes sustainability over short-term fixes.

“What helps most is making small changes with a focus on a balanced diet, which makes it easier to maintain long term,” she adds. “Heart risk is shaped by what we do consistently, not just what we do for a week or two.”

At the same time, the guidelines acknowledge that lifestyle changes alone may not be enough for everyone. Medication—including statins and newer therapies—may be necessary to adequately lower risk.

The Role of Advanced Testing

For some patients, additional testing such as CAC scans, Lp(a) and ApoB measurements can help clarify cardiovascular risk and guide treatment decisions.

“Apolipoprotein B, or ApoB, measures the number of potentially harmful cholesterol particles that can enter artery walls, which can sometimes give a clearer picture of risk than LDL cholesterol alone,” Dr. Johnson explains.

Together, these tools allow clinicians to better identify patients who may benefit from earlier or more aggressive treatment.

Addressing More Than LDL Cholesterol

The guidelines also expand focus beyond LDL cholesterol to include conditions like hypertriglyceridemia.

“Hypertriglyceridemia means triglycerides, another type of fat in the blood, are elevated,” Dr. Johnson says. “That matters because higher triglycerides are linked with cardiovascular risk, and very high levels can also increase the risk of pancreatitis.”

She notes that comprehensive care must address all lipid abnormalities.

“It is important that the guideline includes this because lipid problems are not just about LDL cholesterol; a complete prevention strategy has to address the full spectrum of abnormal blood fats,” she says.

Special Populations and Individualized Care

Another key update is the inclusion of specific recommendations for higher-risk populations, including those with diabetes, chronic kidney disease, HIV, cancer and pregnancy.

“The Dyslipidemia Guidelines highlight that a one-size-fits-all approach is not appropriate,” Dr. Johnson says. “Having condition-specific recommendations helps clinicians tailor care more safely and more effectively instead of treating every patient by the same template.”

Prevention Starts Early—even in Childhood

The guidelines also highlight that cardiovascular risk can begin early in life. Cholesterol screening is now recommended for children between ages 9 and 11.

“This is significant because it reinforces that cardiovascular prevention really is a life-course issue,” Dr. Johnson says. “Screening children around ages 9 to 11 can help identify inherited cholesterol disorders early enough to make a meaningful difference.”

A Call to Action for Younger Adults

The message from cardiologists is clear: don’t wait.

Routine cholesterol screening, understanding personal risk factors and taking early action can significantly reduce the likelihood of developing cardiovascular disease later in life.

Ultimately, the updated guidelines mark a shift toward prevention—recognizing that heart disease is largely avoidable with timely, personalized care.

“This is about making earlier detection lead to earlier treatment,” Dr. Johnson says. “The next step is ensuring these advances are applied consistently and equitably — so more people can benefit from preventive care.”