The American Heart Association and 10 other leading health organizations say it’s time to start checking cholesterol sooner and treating it more aggressively. New, lower low density lipoprotein LDL cholesterol targets are aimed at preventing heart attacks and strokes before symptoms ever appear.

Jason Trager, DO, a cardiologist with OSF HealthCare, says people at risk of heart disease should start trying to lower their cholesterol as early as age 30 and continue into old age. They should also be getting their cholesterol levels lower than many doctors had previously recommended.

Some large clinical studies found that about 72% of high‑risk patients fail to reach guideline‑recommended LDL cholesterol levels, and many are either undertreated or not on medication at all. Recent guideline updates have significantly lowered cholesterol targets, especially for people with heart disease or multiple risk factors.

New LDL cholesterol goals based on risk level

Under the new recommendations, people who have already experienced a heart attack or have symptomatic coronary artery disease should aim for LDL levels below 55. People with underlying but less severe coronary disease or diabetes are encouraged to keep LDL below 70, while the general population should aim for levels under 100.

Dr. Trager says clinical studies show the benefits of lowering cholesterol levels for everyone.

“Lower is better as far as your bad cholesterol level, and it means that a lot of patients who were not taking cholesterol medicines should now be on cholesterol medicines. But the cost-benefit analysis is definitely there. Fortunately, with these new medications, people are living longer.”

Taking a pill every day to lower LDL cholesterol can reduce a person’s risk of heart attack or stroke by 20 to 30%, according to Dr. Trager, and by even more in people with multiple risk factors. He says the benefits are really significant.

New medications improve outcomes and reduce side effects

Advances in cholesterol‑lowering drugs, including combination therapies and injectable medications, have made cholesterol goals more achievable.

“In the past, we were not able to get to these targets without very high doses of medications. So now with some of these newer medications, we can get that. We can get these goals, and that really helps reduce future risk of heart attack and strokes, especially for somebody who already had an event.”

Newer options can also minimize side effects – an issue that often leads people to stop treatment.

High LDL is frequently described as a “silent risk” because people can live for decades without symptoms while damage accumulates inside their arteries. Dr. Trager says this delayed impact makes it harder to convince people to stay on medications. But he tries to help people understand by using an analogy.

“You’re going to replace that tire on your car or you’re going to wait until the big blow out … well, most people would rather replace the tire instead of getting into that big accident,” he explains. “It’s the same analogy. Where your heart is concerned, being proactive and being your own advocate can really reduce future heart attack and risk.”

Other testing to know your risk

Dr. Trager also points to coronary calcium scoring, a specialized CT scan that measures plaque buildup in the heart’s arteries, as a valuable screening tool. While not always covered by insurance, Dr. Trager says the scan can help doctors identify people who would benefit from more aggressive treatment before symptoms appear.

Dr. Trager also recommends that adults have their lipoprotein(a), or Lp(a), measured at least once in their lifetime. High levels of this cholesterol-related particle, largely determined by genetics, are linked to a higher risk of heart attack and stroke.

Dr. Trager stresses the importance of diet and exercise. But for many high‑risk patients, he points out lifestyle changes alone are no longer enough to meet today’s lower cholesterol targets.

“Somebody’s not going to be able to reach those goals with diet and exercise unfortunately,” Dr. Trager shares. “You can go on a straight vegan-type diet and cut out the red meat. You can get the cholesterol level down, but you’re not going to reach those exact goals.”

Dr. Trager encourages people to talk with their medical providers if they struggle with cholesterol medications, rather than stopping treatment entirely. With multiple drug options now available, he says most people can find a regimen that works. He suggests that commitment to taking cholesterol-lowering medication can make the difference between preventing a heart attack and reacting to one.

As new evidence continues to shape clinical practice, Dr. Trager believes the message is clear: knowing your numbers, staying engaged in your care and treating cholesterol early can save lives.

Dr. Trager practices in Bloomington, Illinois but you can talk to your primary care provider to learn more. Don't have one? Here are options. 

Dr. Jason Trager