Below 40? You Should Already Be Getting Screened for Cholesterol, Heart Attack Risks

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Below 40? You Should Already Be Getting Screened for Cholesterol, Heart Attack Risks

New medical guidelines aim to head off damage early with lifestyle changes, screening tests and medication

By Betsy McKay

March 13, 2026

New clinical guidelines recommend screening and treating high cholesterol from age 30, a decade earlier, due to rising heart attacks in younger adults.

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Adults should be screened and treated for high cholesterol starting at age 30, if not sooner, according to new clinical guidelines, lowering the age by at least a decade at a time when heart attacks are becoming more common in younger adults.

The goal is to shift to a more proactive approach to head off problems in younger years, rather than starting lifestyle changes and medical treatment in middle age when a patient may already have damage in their arteries, said Dr. Roger Blumenthal, chair of the committee of cardiologists that wrote the new guidelines.

Growing research shows how much damage can be done when levels of LDL, or “bad,” cholesterol stay high in the blood for years, he said. At the same time, more medicines have become available to lower cholesterol, along with screening tests and a new online tool that allows people 30 and older to calculate their risk of cardiovascular disease.

“We need to pay attention much earlier,” said Blumenthal, director of preventive cardiology at Johns Hopkins Medicine.

The guidelines, published Friday in two leading cardiology journals, were issued by 11 medical associations, including the American College of Cardiology and American Heart Association. These organizations set standards for medical professionals from family doctors to cardiologists.

Approximately 25% of U.S. adults—and 20% of adolescents—have high LDL cholesterol. For adults especially, that increases their risk of heart attacks and strokes because it causes plaque-forming particles to build up in their arteries over time, hardening and narrowing them.

Doctors are being urged to counsel children and adolescents on diet and exercise, avoiding tobacco and other healthy lifestyle habits. More young people are being diagnosed with diabetes and other conditions that put them at higher risk of cardiovascular events.

“If we want to talk about eliminating heart disease and heart attacks, treating cholesterol is one of the most important things,” said Dr. Sadiya Khan, professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine. She wasn’t involved in writing the recommendations.

The new guidelines offer a number of different ways doctors can determine whether a person’s at risk.

Everyone should get a blood test once to measure their levels of lipoprotein(a), another type of “bad” cholesterol linked to heart disease. Researchers say Lp(a), which is genetic, significantly increases the risk of cardiovascular disease, and a test can identify risks for people who are otherwise healthy.

Testing for another protein, apolipoprotein B, can also be performed for those with high triglycerides, diabetes or other conditions, the guidelines say. Research suggests it is a better predictor of heart disease risk than LDL cholesterol.

Men aged 40 and older and women aged 45 and older with a borderline risk of heart attack or stroke may also get a coronary artery calcium scan to check for plaque buildup in arterial walls.

Children should be screened for cholesterol and other lipids once between ages 9 and 11, backing an existing recommendation by the American Academy of Pediatrics. As part of the new guidelines, young adults should be screened beginning at age 19 and every five years after that.

People should be screened for their risk of cardiovascular disease starting at age 30, using an AHA online calculator called Prevent that measures risk based on a person’s cholesterol, blood pressure, and other indicators.

Young adults should be offered cholesterol-lowering medications if their LDL cholesterol is 160 milligrams per deciliter, according to the guidelines. The same is true if they have a family history of atherosclerotic disease at an early age or a high risk of developing it over the next three decades as measured by the Prevent calculator. Adults with genetically high cholesterol should also be put on medication.

While the end result of additional screening may mean more people end up on cholesterol-lowering drugs, younger people may be able to avoid high doses.

“If you identify someone at risk earlier in life, you may not need to treat them with as intensive a statin regimen because you have time on your side,” said Dr. Steven Nissen, a preventive cardiologist at the Cleveland Clinic, who wasn’t involved in writing the new guidelines.