New AHA/ACC Cholesterol Guidelines Urge One‑Time Lipoprotein(a) Testing for All U.S. Adults

The American Heart Association and American College of Cardiology on March 13 released new cholesterol‑management guidelines that call for more aggressive, earlier prevention of heart disease, including a recommendation that every adult in the U.S. receive a one‑time blood test for lipoprotein(a), a genetically determined marker of cardiovascular risk. The guidance, led by Johns Hopkins cardiologist Dr. Roger Blumenthal, says traditional LDL "bad" cholesterol levels alone are not enough and urges doctors to add tools like lipoprotein(a) testing, coronary calcium scans, and a new PREVENT calculator that projects 10‑ and 30‑year risk to decide when to start medication. The document keeps statins as the first‑line treatment but broadens who may receive them, allowing doctors to prescribe cholesterol‑lowering drugs even to people with relatively low short‑term risk when their lifetime risk is high — a shift Cleveland Clinic’s Dr. Steven Nissen calls a "sea change" that will mean many more Americans are treated earlier. Because lipoprotein(a) levels are stable over a lifetime, the test generally needs to be done only once, and elevated results flag inherited risk for heart attacks, strokes and other cardiovascular events. The guidelines also double down on lifestyle changes — diet, exercise, avoiding tobacco and healthy sleep — as the foundation of prevention, but signal that U.S. cardiology is moving toward earlier, more intensive medical intervention to curb a disease that remains the nation’s top killer.