A set of new cholesterol guidelines released in March urges earlier testing and broader risk assessment, as rates of high blood cholesterol rise by more than 13% from 2019 to 2023—along with growing concerns that heart attacks and strokes are showing up in you
For years, high cholesterol was often treated like a problem that waited until later life. But in the U.S., the numbers have been moving the other way—and the new guidance released in March is designed to respond before damage has time to compound.
Cardiovascular disease is the leading cause of death in the U.S., despite being largely preventable. Elevated cholesterol is one of the major risk factors, affecting millions. Still. the CDC data show adults nationwide reporting high blood cholesterol increased by more than 13% from 2019 to 2023. a shift described as a “serious public health challenge.” In Connecticut. more than 38% of adults reported having high cholesterol in 2023.
What makes the trend especially alarming is not just that more people have high cholesterol—it’s that it is showing up earlier. Dr. Mustafa Husaini. a board-certified cardiologist and director of exercise and sports cardiology at Stamford Health. said the rise is happening in a context where other behaviors appear to be improving. “And this is in the setting of people smoking less than they were in the past … so theoretically we shouldn’t be seeing this. but we are. ” he said. He also described seeing patients in their 50s and 60s arriving with heart attacks and strokes.
The March guidance. published by the American College of Cardiology and the American Heart Association in collaboration with other medical associations. is the first update to the cholesterol guidelines since 2018. The core focus is on lowering lifetime risk of heart disease and other cardiovascular issues through earlier testing and broader risk assessments.
Husaini said research over the years has shown some people are at greater risk of heart issues due to underlying factors. and that the new guidelines are meant to reflect those differences while placing greater emphasis on cardiovascular risk over a person’s lifetime. “You may be doing everything right. optimizing your life as best as possible. but at the end of the day. you can’t out-exercise your genetics; you can’t out-eat your genetics. ” Husaini said. “Your genetics are your genetics, and that’s where medications and other things are helpful.”.
Under the updated approach, screening can start earlier for certain children. Children with a family history of familial hypercholesterolemia, a genetic lipid disorder, may be screened as early as age 2. The guidelines also recommend a lipid profile for all children ages 9 to 11 and a one-time measurement of lipoprotein(a). or Lp(a). to identify potential genetic risk factors.
For adults, the guidance also sharpens how clinicians interpret cholesterol numbers in relation to risk. Low-density lipoprotein cholesterol—better known as bad cholesterol—is described by Husaini as both a “risk factor and a risk marker. ” because higher LDL levels are generally associated with a higher risk of cardiovascular diseases.
The guidelines recommend LDL targets based on individual risk: for people diagnosed with intermediate risk of heart disease. LDL should be 70mg/dL or less; for those at high risk. LDL should be at or lower than 55 mg/dL. People with lower risk should still manage their cholesterol levels at or below 100 mg/dL.
They also introduce an updated risk calculator estimating a person’s risk of heart attack, stroke and other cardiovascular events over the next 10 and 30 years. The tool incorporates additional factors, including blood sugar and kidney health, and is recommended for use beginning at age 30.
In terms of treatment. the guidelines emphasize lifestyle and diet recommendations tied to lowering cholesterol long associated with the American Heart Association: being more active. maintaining a healthy sleep schedule. cutting back on tobacco. and more. The updated guidelines also include new recommendations around statin therapy and other lipid-lowering treatments. with guidance for populations including pregnant and lactating women. adults aged 75 and older. and individuals with certain underlying health conditions.
Early diagnosis matters not only in the abstract, but in the choices people make once they learn something about their body.
Robert. a 32-year-old from New Canaan. said he discovered high cholesterol in 2022 but did not address it until a few years later. His family had a history of high cholesterol, which made him curious about his own levels. He said an at-home test showed his cholesterol was “a little high” at the time. “But luckily. like my lipoprotein A and my HDL (high-density lipoprotein) and all the other ones seemed normal. ” Robert said. asking to use only his first name for privacy reasons. “So I just made note of it. left it on the back burner. continued to eat as I was and exercise as I was.”.
Robert continued to check his levels over the years and slowly adjusted his lifestyle and diet. His first appointment with Husaini was in spring of 2026.
“It can be discouraging to get a diagnosis at a young age,” Robert said. But he added that a label does not determine the whole outcome. “healthcare is not one size fits all.” He said receiving a diagnosis does not guarantee the same outcome as the statistical probability tied to that diagnosis. especially when someone is young. “If you’re young, you have the ability, thankfully, to address it earlier.”.
His routine—what he called the “bare bones” of his lifestyle—hasn’t changed much since diagnosis. He still exercises regularly, with a greater focus on aerobic and cardio workouts. He has also shifted toward more whole foods, incorporating more fiber and cutting back on full-fat dairy products.
One of the bigger changes has been trading red meat, like steak, for lean meats and fish. Robert described it as a transition he is still getting used to. “I think if you prioritize longevity or being as healthy as you can moving forward. then eating salmon is not as bad as not eating a rib eye. ” he said.
For Husaini. the takeaway from the new guidelines is straightforward: they give providers and patients a chance to start discussing cholesterol management earlier in the care process. Even with broad recommendations, he emphasized that care and treatments differ depending on individual circumstances.
He also said that if early changes don’t work, there are many other tools and options to help people lower their cholesterol levels and reduce future risk of heart disease. He added that the updated guidelines may also lead to broader insurance coverage and reimbursement for certain treatments.
“I think prevention is obviously the most important thing that we can do for people’s heart health,” Husaini said.
For Robert, the message lands differently because he lived the delay. His experience points to the uncomfortable reality behind rising cholesterol numbers: once a result is known, the next question becomes whether time gets used well—before risk turns into something harder to reverse.
cholesterol guidelines American College of Cardiology American Heart Association early screening LDL targets lipoprotein(a) Lp(a) cardiovascular risk statin therapy