New US Cholesterol Guidelines Add PREVENT Risk Calculator
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- American College of Cardiology and the American Heart Association released updated cholesterol guidelines—their first since 2018—published in JACC and Circulation and presented March 28 at the ACC's 75th Annual Scientific Session in New Orleans.
- Roger S. Blumenthal, chair of the guideline writing committee, said roughly 80% to 90% of cardiovascular disease is linked to modifiable factors, and the new guidance urges earlier screening—starting around age 9 for children with familial hypercholesterolemia.
- The guidelines recommend a one-time test for lipoprotein(a), or Lp(a), which can raise heart disease risk by about 40% at levels of 125 nanomoles per liter and roughly double the risk at 250 nanomoles per liter.
- A new risk calculator called PREVENT (Predicting Risk of Cardiovascular Disease EVENTs) estimates 10- and 30-year risk starting at age 30 and was built on data from 6.6 million people, compared with about 26,000 in the prior model.
- LDL-C targets were tightened: below 100 mg/dL is considered optimal, below 70 mg/dL for intermediate-risk individuals, and below 55 mg/dL for high-risk patients, with additional non-HDL and apolipoprotein B targets included.
- Treatment options were expanded beyond statins to include ezetimibe, bempedoic acid, and injectable PCSK9 monoclonal antibodies, with specific guidance for pregnant or breastfeeding individuals, adults 75 and older, and patients with diabetes, advanced kidney disease, HIV, or cancer.
- About 1 in 4 U.S. adults has elevated LDL cholesterol, and the guideline lists 'risk enhancers' such as high-sensitivity C-reactive protein, family history, ancestry, and coronary artery calcium scans to refine borderline or moderate-risk decisions.
Why it matters: Roughly 1 in 4 U.S. adults has elevated LDL cholesterol, and the new PREVENT calculator expands predictive power from a 10-year horizon to 30 years—meaning Americans as young as 30 can now get a personalized heart attack and stroke trajectory, with tightened LDL targets that may push high-risk patients toward earlier, more aggressive combination therapy.
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