Cholesterol control gets personalized—how new guidelines tailor treatment to your unique risk profile

Every day, about one in four Americans experience dyslipidemia, a condition where levels of cholesterol or fatty acids in the blood are too high. If left untreated, this can lead to atherosclerotic cardiovascular disease (ASCVD), a group of diseases caused by plaque buildup in blood vessels that can result in heart attacks or strokes.

As a cardiologist with a focus on sports and exercise science, I regularly work with patients who want to adopt healthier lifestyle habits to manage their cholesterol levels and lower their risk of cardiovascular disease.

In March 2026, the American Heart Association and the American College of Cardiology released new guidelines on treating dyslipidemia, an update to guidelines last revised in 2018. These new guidelines consider recent studies and aim to personalize treatment plans to better suit each patient's unique risk profile.

The updated guidelines encourage doctors to begin treating high cholesterol earlier and more aggressively. This is because the longer cholesterol levels remain elevated, the greater the long-term risk of cardiovascular disease. To assess a patient's risk, physicians can use blood tests like standard lipid tests for LDL (bad cholesterol) and HDL (good cholesterol), as well as newer tests for lipoprotein A (LpA) and apolipoprotein B (ApoB).

They also recommend checking coronary artery calcium (CAC) levels, which were not included in previous guidelines.

An online calculator called PREVENT-ASCVD can help providers determine if a patient is at low, intermediate, or high risk for cardiovascular disease. This risk assessment considers factors such as body mass index, blood pressure, diabetes history, kidney function, and smoking status. Based on a patient's risk level, the guidelines suggest several newer classes of medications that can be added to a treatment plan for high cholesterol.

While statins like atorvastatin and rosuvastatin remain the standard of care, other medications may be recommended if statins alone don't achieve cholesterol goals or if patients experience bothersome side effects.

Although LDL and HDL cholesterol have long been key markers for cardiovascular disease risk, the new guidelines also emphasize the importance of newer biomarkers. ApoB, a protein found on plaque-forming particles like LDL, can more accurately predict cardiovascular disease risk than LDL alone, especially for those with diabetes or metabolic syndrome.

LpA, a molecule similar to LDL cholesterol with an extra protein attached, may also increase a person's lifetime risk of cardiovascular disease. Checking LpA levels once in all adults can help determine their lifetime risk.

The guidelines also discuss coronary artery calcium (CAC) scores, which are obtained through a CT scan. These scores measure calcium deposits in the arteries around the heart, with higher scores indicating a greater risk of cardiovascular disease. Based on these scores, the guidelines provide patient-specific targets for managing cholesterol, reflecting their goal of personalizing treatment according to each patient's risk profile.

Overall, these new guidelines shift cholesterol management toward earlier screening and more personalized treatment. They promote lifelong prevention strategies to reduce the risk of cardiovascular disease, starting with early cholesterol checks for children ages 9 to 11 and annual screenings for adults starting at age 19. For those at increased risk, medication may be considered as early as age 30.