New guidelines released in March 2026 by the American Heart Association and the American College of Cardiology change how doctors treat high cholesterol. These are the first updates since 2018, and they push for earlier and more tailored care based on each person's own risk.

What this means for you

If you have never had your cholesterol checked, or you have not had it checked in years, these new rules may affect you. This site exists to explain health news like this in plain words, so you do not need a medical dictionary to understand what your doctor might tell you next.

High cholesterol, also called dyslipidemia, affects at least a quarter of Americans. It raises your risk of atherosclerotic cardiovascular disease, or ASCVD. This is plaque buildup in your blood vessels that can block blood flow and lead to heart attack or stroke.

Why the guidelines changed

Doctors have long used LDL, the "bad" cholesterol, and HDL, the "good" cholesterol, to judge heart risk. The new guidelines still use LDL, but add two newer blood tests: apolipoprotein B (ApoB) and lipoprotein A (LpA). ApoB counts plaque-forming particles, which can be more useful than LDL alone for people with diabetes or metabolic syndrome. LpA is a stickier molecule that raises lifetime heart risk, and the guidelines say every adult should have it checked at least once.

The guidelines also recommend a coronary artery calcium scan, a CT scan that measures calcium buildup in arteries around the heart. More calcium means higher risk. Doctors can now combine this scan with an online tool called PREVENT-ASCVD, which factors in things like body mass index, blood pressure, diabetes history, kidney function and smoking status to estimate your 10-year and 30-year heart risk.

What doctors will do differently

1. Check cholesterol in children ages 9 to 11.
2. Test adults every five years starting at age 19.
3. Consider starting medication at age 30 for higher-risk adults.
4. Use a four-step approach called CPR: calculate risk, personalize it with family history and test results, reclassify with imaging, then reassess treatment.

Statins like atorvastatin (Lipitor) and rosuvastatin (Crestor) remain the main treatment. If statins alone do not work, or cause side effects, doctors now have newer drug options to add.

Lifestyle still matters most

The guidelines stress diet changes, like cutting sugar, refined carbs, saturated fat and alcohol. They recommend 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week, plus two days of resistance training. For those who are overweight or obese, losing 5% to 10% of body weight is advised.

Your next step: ask your doctor if it is time for a cholesterol check, and whether tests like ApoB, LpA or a calcium scan make sense for you.