Dr Saheb Sahu, MD, MPH.
What Is Cholesterol?
Cholesterol is a waxy, fat-like substance produced by the liver which the body uses to build cell membranes and hormones. Our body needs some cholesterol but having too much increases the risk of high blood pressure, heart disease and stroke.
There are two kinds of cholesterols: 1- LDL (Low Density Lipoprotein), 2- HDL (High Density Lipoprotein). HDL is considered the good cholesterol. It protects our arteries and lowers the risk of high blood pressure, heart disease and stroke. LDL is considered the bad cholesterol. It causes atherosclerosis (building of plaque) by infiltrating the artery wall and triggering an immune response that forms plaque. Plaque inside the artery leads to the thickening of artery and lead to high blood pressure, heart disease and stroke.
New guidelines for screening of cholesterol were published by the American College of Cardiology (ACC) and American Heart Association (AHA) on March 13, 2026. This new guidelines replaces the guidelines of 2018.
2026 Guidelines
1- Start Screening Early
.Initial Lipid Screening:
.Begin around age 19-21
.Repeat Screening:
. About every 5 years in healthy adults if results are normal
2- Heart Disease Risk Assessment Begins at Age 30
The guidelines recommend using the new PREVENT-ASCD risk calculator to estimate
. 10- Year cardiovascular risk.
. 30- Year risk cardiovascular risk for adults 30-79 years old.
3- Additional Screening Tests Recommended
Beyond the traditional lipid panel (HDL, LDL cholesterol and Triglycerides), physicians should consider measuring:
.Lipoprotein (a)-Lp (a)
.Apolipoprotein B (APO B)
.Coronary Artery calcium score in selected patients.
These above tests help detect hidden cardiovascular risk not seen in standard cholesterol tests.
4- Screening Children and Young Adults
.Children: one cholesterol screening age 9-11.
.Young adult- by age 19-21.
5- Who Needs More Frequent Screening?
Earlier screening is advised for people with:
.LDL more than 160 mg / dl
.Family history of cardiovascular disease
.Diabetes
.Genetic lipid disorder
.High life-time risk by PREVENT- Calculator
Key Message for Individuals
1-Eat a diet full of vegetables, fruits, whole grains, beans, nuts, seeds, unsaturated fats and lean proteins as part of an overall healthy eating plan. Limit ultra-processed foods that are high in saturated fats, added sugar and salt.
2-Make Life-style changes:
. Get regular physical activities
. Maintain a healthy weight
. Avoid tobacco products and minimized alcohol intake
. Manage your high blood pressure, cholesterol and blood sugar
. Get 7- 9 hours of sleep
3- Children should be screened for cholesterol once between age 9-11 and young adult at 19.
Sources
- 2026 Guidelines on the Management of Dyslipidemia
- American Heart Association PREVENT Online Calculator
- Professional.heart.org
