MW Get an Lp(a) test - and 3 other things you must do now for heart health
By Martha Gulati
I'm a cardiologist. Here are the most important new guidelines that younger people need to know about when it comes to their heart health.
Physicians are now urging younger adults to get screened for heart disease.
We have all seen the headlines about deaths from heart disease rising in younger people.
This has prompted many of us in preventive cardiology to question how well cardiovascular disease prevention is working if mortality is so high. How should we tackle the expected rise in heart disease in women and men? How does cardiovascular disease prevention need to change?
There are now new guidelines, which were published Friday by the American College of Cardiology and the American Heart Association, that will change how we think about cardiovascular disease prevention - and specifically cholesterol. We already know that lifetime exposure to high LDL, or low-density lipoprotein, increases cardiovascular risk, and that getting care earlier can help prevent heart disease. That's where the focus of cardiovascular care really needs to be.
Heart disease remains the leading killer of both men and women in the U.S., and the new guidance emphasizes that prevention must start decades earlier than traditionally thought.
Even kids need to be screened
The process of atherosclerosis - the slow buildup of plaques on the artery walls that can lead to heart attacks, strokes and other events - begins long before symptoms occur. If we start screening younger people who are at risk earlier, we can hopefully intervene and change the trajectory of the disease.
The prior guidelines focused on adults age 40 and older, but the new recommendations highlight the importance of early risk detection and treatment in younger adults and children. We now recommend that all children have their cholesterol assessed between the ages of 9 and 11, and that children with a strong family history of early heart disease or known genetic diseases like familial hypercholesterolemia be screened by age 2.
It's time to look at risk over a lifetime, not just 10 years out
In younger adults, focusing on short-term risk often underestimates the probability that they can get sick later in life. It can be misleading in terms of understanding the consequences of elevated lipids in the long term and give false reassurance to any young person who gets a risk assessment done. Identifying risk earlier will hopefully mean more patients will undergo aggressive treatment sooner and incorporate any needed lifestyle changes and medications.
Managing LDL is still the main goal
Low-density lipoprotein, or LDL, is what we call "bad" cholesterol, and it remains the central focus of cholesterol management. The new guidelines brought back thresholds for LDL cholesterol. This is consistent with the European Society of Cardiology's recommendations and something that I and others have been calling for.
Lipid management, which is central to preventing heart disease, traditionally hasn't had thresholds that explain how much someone is at risk of a serious event. In fact, the National Committee for Quality Assurance only tracked whether someone was on a statin, and their adherence to it. This ignored two things: the important nonstatin treatments that have come to market over the last decade, and the importance of helping a patient get their LDL to a specific number depending on their risk level. This can sometimes take more than one type of medication. Creating these thresholds that show whether someone is at very high risk, high risk or moderate risk will help people with elevated cholesterol understand the goal of treatment and work with their physicians to get there.
For people with abnormal levels of lipids, which are called dyslipidemias, lifestyle interventions remain key. Follow a Mediterranean-style diet, get regular physical activity, manage your weight, avoid smoking, get your blood pressure under control and try to get adequate sleep.
These patients can also take statins and nonstatin therapies like ezetimibe, PCSK9 inhibitors like Amgen's $(AMGN)$ Repatha or Regeneron $(REGN)$/Sanofi's (FR:SAN) Praluent, and Esperion Therapeutics' $(ESPR)$ bempedoic acid drug Nexletol. Limiting lifetime exposure to elevated LDL is the key to reducing atherosclerosis, and that's why the guidelines emphasize treatment in young adults, even those as young as 30, for those considered at high risk. But they should also avoid commonly used and unproven supplements like fish oil, cinnamon and turmeric.
Everyone needs one Lp(a) test
Another important update emphasizes the need for lipoprotein(a) testing once in every person's lifetime. Finally, we have caught up with the Europeans and Canadians. Less than 1% of the U.S. population has had their Lp(a) checked, and yet one in five people have elevated Lp(a).
Those with elevated Lp(a) are at high risk for cardiovascular events but often remain unidentified until an event like a heart attack or stroke occurs. Lp(a) is largely determined by genetics and is relatively stable throughout a person's life. It should now be part of everyone's routine assessment. The blood test often costs less than $100 when paid for directly.
Martha Gulati is a preventive cardiologist and the inaugural director of the Davis Women's Heart Center at the Houston Methodist DeBakey Heart & Vascular Center. She is the immediate past president of the American Society for Preventive Cardiology and the co-author of the book "Saving Women's Hearts."
-Martha Gulati
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March 19, 2026 11:29 ET (15:29 GMT)
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