Washington Post [no paywall] “This month, the American College of Cardiology, American Heart Association and nine other medical organizations released a comprehensive revision to their 2018 guidance on how to manage high cholesterol, one of the leading causes of heart disease. These new recommendations — which will affect medical care for millions of Americans by emphasizing earlier, more proactive treatments — mark a meaningful step in the right direction. High cholesterol, specifically elevated levels of low-density lipoprotein (LDL) cholesterol, has long been recognized as a major driver of heart attack and stroke. Yet prior guidance focused on estimating a person’s cardiovascular disease risk over the next 10 years to determine when to begin treatment and did not set clear target levels for LDL cholesterol. Perhaps the most consequential change in the new guidelines is the move to consider not only a patient’s 10-year risk but also their 30-year risk. The guidelines endorse a risk calculator known as PREVENT, which uses factors including blood pressure, cholesterol levels, diabetes status and smoking history to estimate both medium- and long-term risk. This is important because someone with a low 10-year risk might have a high 30-year risk and should consider lipid-lowering treatment. This reflects the reality that plaque builds gradually in the arteries over time, and that earlier intervention can reduce the cumulative exposure to harmful cholesterol that drives this process. The second crucial difference is that the updated guidance sets clear targets for cholesterol levels. Specifically, most people should aim for a level below 100 milligrams of LDL cholesterol per deciliter of blood. For those with a 10 percent or greater risk of having a significant cardiovascular event in the next 10 years, the goal drops to below 70 milligrams. And those who already have cardiovascular disease has an even lower target of below 55. These thresholds reflect growing consensus that reducing LDL earlier and maintaining it at lower levels leads to substantially greater protection against heart attack and stroke…”