Q&A: What do new heart health guidelines mean for you?

March 20, 2026
A doctor and patient having a conversation in an examination room.

UVA cardiologist Dr. Christopher Kramer recommends raising any questions about the new guidelines with providers. (Illustration by Johnny Utterback, University Communications)

New national guidance on heart disease from a coalition of medical associations, including the American Heart Association and the American College of Cardiology, could mean earlier screening, new testing and more proactive treatment – even for younger people. 

Portrait of Dr. Christopher Kramer.

Kramer heads the American College of Cardiology (contributed photo).

Dr. Christopher Kramer, a cardiologist, chief of the Division of Cardiovascular Medicine at UVA Health and president of the American College of Cardiology, talked about the key takeaways with UVA Today.

Q. What is most important for people to know?

A. The goal must be, as it has always been, to limit one’s risk factors. The risk factors for coronary artery disease are high blood pressure, diabetes, cigarette smoking, elevated cholesterol, family history of heart disease and obesity. You can’t change your family history, but you can control your blood pressure, prevent diabetes, stop or not smoke, lower your cholesterol and try to avoid obesity.

Q. Should I be screened or talk to my doctor about this?

A. Yes, all patients should have their cholesterol measured, initially at the age of 9-11, again beginning at age 19 and at least every five years thereafter. In those with a known family history or genetic causes of high cholesterol, the recommendation is to start screening at age 2 and above.

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Q. What changes in the guidance are most significant?

A. The first is to treat earlier in the lifespan, because it’s a lifelong disease. That’s especially true of patients with genetic causes of high cholesterol who are at high risk for premature cardiovascular disease.

The second is to use a more advanced version of a risk equation developed by the American Heart Association in the past couple of years, called PREVENT, to assess 10- and 30-year risk, rather than five- and 10-year risk. This is especially important in younger patients.

The third is lowering the threshold for treating LDL (low-density lipoprotein, or “bad” cholesterol) now that a 3-5% 10-year risk for heart attack is considered borderline and a 5-10% 10-year risk is considered ideal for treatment.

The fourth recommendation is that lipoprotein(a), or Lp(a), is measured at least once in one’s lifetime as a risk modifier. Right now, if your Lp(a) is elevated, the best we can do is lower LDL with a statin or other drug therapy. But over the next three to four years, several trials of drugs specifically aimed at lowering Lp(a) will be finalized and published, so we’ll know whether there are actually specific drugs that treat this marker and improve outcomes.

Q. What does the guidance say about people in higher-risk groups?

A. The guidelines advised increased emphasis on calcium scoring in men over 40 and women over 45 to help guide the use of LDL lowering, especially in intermediate risk patients. Women demonstrate calcification in their coronary arteries (a marker of the presence of coronary artery disease) on average five or 10 years later than men.

There’s also a renewed emphasis on primary prevention and on certain risk groups for which LDL lowering is essential, regardless of baseline. These risk groups include diabetics, patients with chronic kidney disease and those who are HIV positive.

Media Contacts

Eric Swensen

UVA Health System

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