New Cholesterol Guidelines
Every few years, the science of cardiovascular health evolves — and this month, the medical community released the most significant update to cholesterol guidelines in nearly a decade. As your physician, I want to break down what changed, what it means for your care, and what you should be asking about at your next visit.
The Big Picture
The guidelines have been expanded from managing cholesterol alone to managing the full picture of cardiovascular risk — including markers most patients have never heard of. The name change says it all: we've gone from "Blood Cholesterol" to "Dyslipidemias," reflecting a broader, more precise approach to heart health.
What's New — In Plain Language
Your LDL target is back. For years, guidelines moved away from specific numbers in favor of percent reductions. That's changed. If you have established heart disease or are at very high cardiovascular risk, your LDL goal is now under 55 mg/dL. For others with heart disease history, the target is under 70. Having a clear, personal goal matters — it creates accountability for both of us.
We're starting conversations earlier — at 30. Cholesterol damage accumulates silently over decades. The new guidelines recommend screening and risk assessment beginning at age 30, not 45 or 50. If you have a family history of heart disease, high cholesterol, or early cardiovascular events, this is especially important.
Lp(a) is now a lifetime must-check. Lipoprotein(a) — or Lp(a) — is a genetic form of cholesterol that standard lipid panels don't capture, and that statins don't lower. The new guidelines classify measuring it as a Class 1 recommendation — meaning every adult should have it checked at least once. I have been ordering this on my patients for years. If you haven't had it checked, let's talk.
A smarter risk calculator. The old tool used to estimate your cardiovascular risk has been replaced by the PREVENT calculator, which now maps both your 10-year and 30-year risk. This longer horizon is central to longevity medicine — we're not just managing your health today, we're protecting your future.
Beyond LDL: ApoB and triglycerides matter too. Your full cardiovascular story isn't told by LDL alone. ApoB — a protein that carries cholesterol particles — and triglyceride-rich remnants are now formally incorporated into risk assessment. A complete picture leads to better, more personalized decisions.
Your Takeaways
🔲 Know your LDL number — and your goal. Not just whether it's "normal," but where it should be given your personal risk profile.
🔲 Ask about Lp(a). If you haven't had it checked, request it. It's a one-time test that could change your entire treatment approach.
🔲 If you're in your 30s, don't wait. Now is exactly the right time to establish a baseline and understand your long-term trajectory.
🔲 Ask your doctor about ApoB. It's a more precise marker of cardiovascular risk than LDL alone — and it's now part of the standard of care.
🔲 Review your risk with the PREVENT calculator. Your 30-year risk picture may look very different from your 10-year number.
