Here’s some exciting news for your heart: The rules around cholesterol just got simpler, smarter and more personalized with an earlier start on primary prevention.
American College of Cardiology and American Heart Association released updated cholesterol guidelines that could help you prevent heart disease decades before it starts by giving you clearer, easier-to-understand targets to work toward.
Break down the biggest changes and what they could mean for your health.
What is cholesterol?
Cholesterol is a waxy, fat-like substance that your body uses to make cell membranes, hormones, vitamin D and bile acids. Your liver makes all the cholesterol you need. The issue is not that cholesterol exists; it is that too much atherogenic cholesterol, especially ‘bad’ LDL cholesterol, can build up in artery walls and raise the risk of heart attack and stroke.
[‘Good’] HDL helps carry cholesterol back to the liver.
The new 2026 cholesterol guidelines
Earlier risk assessment age
Adults in their 30s and up are now included in the risk assessment group rather than adults 40 and up. The new guidelines expand risk assessment to adults ages 30 to 79 and consider both short and long-term risk.
What does it mean?
Younger people will be screened for cholesterol issues, and screenings may happen even more often for those with risk factors like family history, high blood pressure, autoimmune disease or pregnancy complications such as preeclampsia.
More focus on lifetime prevention
The new guidelines recognize that heart disease doesn’t develop overnight. It takes decades to develop. Instead of waiting until risk is high later in life, doctors are now looking at long-term [30-year] risk, not just 10-year risk, and are paying closer attention to people who have a high LDL when young or a strong family history of heart disease.
What does it mean?
This shift may lead to earlier lifestyle changes and, for some people, the use of medications so that plaque buildup is prevented long before a heart attack occurs.
Clearer LDL cholesterol targets
The updated guidelines bring back specific LDL cholesterol goals, which were less emphasized in the 2018 recommendations.
For people at low risk of heart disease, LDL should be under 100 mg/dL, while those at higher risk may be advised to aim for under 70 md/dL and those at very high risk for under 55 mg/dL.
What does it mean? The updated approach is simpler. Since patients will know their target LDL number and whether they are on track, some patients may be advised to aim for lower LDL levels than they were previously told, especially if they have a history of heart disease, diabetes, kidney disease or strong family risk.
A new focus on Lp(a) testing
The new cholesterol guidelines highlight lipoprotein(a), or Lp(a), as an important risk marker and recommend one-time testing in adulthood.
Lp(a) is a particle in the blood that looks a bit like LDL. It is mostly genetics. [Being] born with high Lp(a) can significantly increase your risk of heart attack, stroke and aortic valve disease.
What does it mean?
It can uncover a hidden risk if the rest of your cholesterol panel looks okay. If the Lp(a) is high, your doctor may take a more proactive approach and recommend additional testing.
The bottom line on the new cholesterol guidelines
The more we learn about how the body works, the better we get at protecting it. These updated guidelines give you clearer cholesterol targets, earlier screening options and a smarter roadmap to keep your heart healthy for decades to come.