Top 10 Things to Know About the ACC/AHA Cholesterol Guideline

1. Enjoy vegetables, fruits, whole grains, beans, nuts, seeds, unsaturated fats and lean proteins as part of an overall healthy eating pattern. Limit ultraprocessed foods that are high in saturated fats, added sugars and sodium.
2. Understand lifestyle changes that can lower your cholesterol. You can create habits that support your heart health including maintaining a healthy weight, getting regular physical activity, avoiding tobacco products, managing blood pressure, diabetes and cholesterol, and prioritizing 7–9 hours per day of restful sleep.
3. Take action early in life because high cholesterol can begin to impact your heart disease risk even in childhood and adolescence. Having regular checkups is important to understand your personal risks.
4. Children may have high cholesterol due to inherited conditions or unhealthy habits. Talk with your child’s health care team about this health risk, especially if your family has a history of high cholesterol, heart disease or stroke. Cholesterol screening is recommended for all children between the ages of 9-11 years old who have not previously been screened to help assess risk and guide care, in collaboration with clinicians, parents and caregivers.
5. Discuss with your health care team which screenings may be appropriate for you and if any treatment is recommended. Screenings may include:
   
   Cholesterol Panel – All adults 19 and older should have a cholesterol blood test panel that includes total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride levels. 
   
   Lipoprotein(a) or Lp(a) – New guidance recommends that every adult get tested for lipoprotein(a), or Lp(a), at least once in their lifetime. High Lp(a) levels (125 nmol/L or 50 mg/dL and above) are often inherited. Lp(a) levels should be combined with other health measures to assess heart disease or stroke risk and help guide next steps in prevention or treatment. 
   
   Apolipoprotein B or ApoB – Testing for ApoB can help when someone has high triglycerides, metabolic syndrome or type 2 diabetes. These conditions can increase the number of harmful cholesterol particles in the blood, even when LDL cholesterol looks normal. An ApoB test gives a clearer picture of heart disease risk.
   
   Coronary Artery Calcium (CAC) Scan – Men 40 and older and women 45 and older can be considered for a CAC scan to check the artery walls for early plaque buildup. This simple imaging test is most useful if the decision to start a cholesterol lowering medication is uncertain. 
6. Your health care team may use a new risk estimator called PREVENT to estimate your chances of having a heart event or stroke in the next 10 and 30 years. This tool helps guide treatment plan decisions for you and your health care team. The risk estimate is based on health information typically collected during your annual check-up, such as age and blood pressure readings, along with cholesterol test results and other personal details.
7. Dietary supplements are not recommended for cholesterol management. If you take any supplements, talk with your health care team because some may have interactions with prescription medications.
8. For women, some reproductive health conditions can raise risk of heart disease and stroke, even years later. Share your pregnancy and reproductive history with your health care team to understand your risk and know your numbers including cholesterol, blood pressure, blood sugar and body mass index.
9. People with some health conditions and high cholesterol may be at higher risk for a heart event or stroke. These conditions include type 2 diabetes, cardio-kidney-metabolic syndrome, HIV infection, history of cancer or current cancer diagnosis. Lowering cholesterol can help reduce the risk of a serious heart problem.
10. In addition to adopting healthy lifestyle habits for lowering cholesterol levels, you may be prescribed a cholesterol-lowering medication. If you experience medication side effects, there are other medications available that may be a better fit for you.

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