Ask The Expert: What Do the New Cholesterol Guidelines Mean for Me?

May 18, 2026

New guidelines from the American College of Cardiology and the American Heart Association for cholesterol levels were informed by a 2020 paper co-authored by Charles (Chaz) Hong, MD, PhD, Chair of Medicine in the MSU College of Human Medicine. The landmark updates emphasize starting screening and intervention, including through medication, at a much younger age. Hong, a cardiologist and a researcher, discusses why he believes the guidelines have the potential to save millions of lives.

Why are cholesterol levels important?

Elevated cholesterol levels are major contributors to heart disease, the No. 1 cause of death and disability. Cholesterol is a natural substance in our bodies, and some types, such as high-density lipoprotein (HDL) help protect heart and vascular health.

But abnormal levels of certain lipids or lipoproteins such as low-density lipoprotein cholesterol (LDL-C) can lead to a buildup of fatty deposits in the arteries, a leading cause of death. It’s no surprise LDL-C is known as the “bad” type of cholesterol for the role it plays in heart disease and stroke.

How common are abnormal levels of cholesterol?

Very common and often undetected. The American Heart Association estimates one in four adults have high LDL-C. The Centers for Disease Control and Prevention says nearly 94 million Americans 20 or older have “borderline” high cholesterol. But people may not realize their risk unless they visit their doctor and have their blood checked. That’s because abnormal blood cholesterol — the medical term is dyslipidemia — often has no symptoms.

What is the impact of these new guidelines?

These are significant updates with the potential to save millions of lives. One of the most important changes is that the guidelines widen the window for checking cholesterol levels, starting at age 19. This builds on research, including the 2020 paper I co-authored, Time Course of LDL Cholesterol Exposure and Cardiovascular Disease Event Risk. We found that exposure to high cholesterol happening over a lifetime can be a better measure of long-term risk than a snapshot of cholesterol level later in life. The good news is early intervention can reduce risk later.

Why does earlier screening and intervention matter?

Heart disease doesn’t happen overnight. It happens over decades. And because LDL-C has such a significant role in heart disease, the goal is to keep levels lower for longer. Sometimes that can be accomplished through diet and exercise, and certainly through lifestyle changes like quitting smoking. But we also have a proven type of medication, statins, that have saved hundreds of millions of lives by reducing cholesterol and even shrinking plaque buildup.

Thanks to statins, it is no longer common for people to die of a heart attack at 55. And the new guidelines support earlier use of statins to lower cholesterol, including for young patients. This has the potential to save millions of lives. Statins have the added benefit of being very inexpensive.

The biggest obstacles are skepticism and misinformation. But if we could actually have high-risk people adopt this practice, starting statins in their 30s or 40s — when it could really make a difference — then I think that we could dramatically reduce the rate of stroke and heart attacks in 30 years.

How do I know my risk?

Start a conversation with your doctor, have a lipid panel drawn. Your cholesterol level is part of the risk equation, along with family history, lifestyle, and so on.

The guidelines include a new calculator, Predicting Risk of Cardiovascular Disease EVENTS (PREVENT), which, starting at age 30 can consider multiple factors to determine risk of heart disease in 10-year and 30-spans. This shifts the focus from the previous risk factor, aging, to look at multiple contributors to risk and then assessing optimal cholesterol levels accordingly.

What do the new guidelines say to you as a researcher about the value of science?

To take our paper as an example, that was based on data from the Coronary Artery Risk Development in Young Adults Study (CARDIA). This was a famous study launched in the 1980s that enrolled thousands of test subjects, checking their cholesterol and health over decades.

This is an investment the government and the people of America made 40 years ago that's paying dividends now — that’s forty years of solid evidence. And then the new guidelines built on that, along with dozens of other studies. Eleven different medical societies came to consensus, which was then peer-reviewed by dozens of the nation’s top scientists and physicians.

A lot of the people think the science has people come up with a brilliant idea in the middle of their dreams. But a lot of it is just slow, steady work.

The fact that we increased our life expectancy from 30 in 1900 to almost over 85 in less than 150 years, it’s all because of Western medicine and the power of empirical observation, critically testing the hypothesis and seeing whether what we say is actually true.

By Darin Estep

Media Contact | Emily Linnert