The new guidelines emphasize that not only cholesterol levels matter, but also the number of years the arteries are exposed to them, and therefore in some people monitoring and treatment begin already around age 30.
If we once used to think that cholesterol testing is a matter for age 40 and above, the new recommendations from leading cardiology associations around the world change the picture. According to the updated guidelines, the conversation about cholesterol, cardiac risk and LDL targets should start much earlier, sometimes already around age 30.
The central message of the guidelines is simple: Not only how high your cholesterol is matters, but also how many years your arteries are exposed to it. The longer the exposure, the higher the risk of plaque buildup, heart attacks and stroke.
Why the recommendations have changed now
The new guidelines from the American College of Cardiology and other medical bodies are based on the understanding that cardiac risk is cumulative.
If in the past doctors focused mainly on the risk over the next ten years, today there is also emphasis on risk 30 years ahead, especially between ages 30 to 59. This means that even a relatively young person who appears “healthy” may be recommended early treatment if their cumulative risk is high.
In practice, this changes the entire concept of prevention: Instead of waiting for levels to worsen, the goal is to reduce as early as possible the number of years in which the arteries are exposed to high LDL.
Which tests are important to do
The basic test is a blood lipid profile, which measures LDL, HDL and triglycerides.
According to the guidelines, from age 19 it is recommended to perform a cholesterol test at least once every five years, and in some cases even more frequently.
But the major innovation is the recommendation to test at least once in a lifetime also Lipoprotein(a), or Lp(a), a type of fat that is genetically determined and may significantly increase the risk of heart disease even if other markers are normal.
In some cases, doctors may also recommend an ApoB test, which is considered more accurate in people with diabetes, obesity or metabolic syndrome.
How much should cholesterol be lowered?
One of the major updates in the guidelines is clear LDL targets according to risk level.
For most people with borderline or moderate risk, the target is below 100. In people with high risk, such as long-term diabetes, arterial calcification or multiple risk factors, the target drops below 70.
For those who have already had a heart attack or stroke, the recommendation is even stricter: LDL below 55.
The reason is simple: Studies show that when LDL is aggressively reduced, not only does plaque buildup stop, but sometimes it even shrinks.
The update most likely to spark discussion is the recommendation to consider drug treatment already around age 30 in some people.
This does not mean that everyone who turns 30 should start taking statins, but rather that from this age it is important to carry out a structured risk assessment, especially if there is a family history, abdominal obesity, high blood pressure, diabetes, kidney disease or smoking.
The medical logic is clear: Just as smokers count “pack-years,” cholesterol is also measured by years of arterial exposure. The earlier LDL is reduced, the more cumulative damage is prevented.
And what about calcium in the arteries? In people with unclear risk, an important tool is a coronary calcium scan (CAC), a low-radiation CT scan that checks whether plaque is already present in the heart arteries.
This test can help decide whether medication is really needed or whether lifestyle changes are sufficient.
Does everyone need statins?
Absolutely not. The guidelines emphasize that statins are still the first-line treatment, thanks to their effectiveness, low cost and decades of experience.
But if there are side effects, or if LDL does not reach the target, there are now alternatives such as ezetimibe, bempedoic acid, PCSK9 inhibitors, and in the near future also next-generation oral drugs. The message is that there is no need to give up if one medication does not work.
What can be done without medication?
First and foremost, lifestyle change. The most recommended diets are the Mediterranean diet or DASH:• More vegetables• Legumes• Fish• Olive oil• Nuts• Whole grains• Less ultra-processed food, trans fats and sugar
Regular physical activity, weight loss, good sleep and quitting smoking also have a dramatic effect on risk.
The new guidelines are not meant to cause alarm, but to improve precision. The important message is that cholesterol is no longer something to think about only in your 50s or 60s. For some people, true prevention begins already in the third decade of life.The earlier risk is identified, the easier it is to prevent the first cardiac event.
Source:
www.jpost.com
