The announcement sent shock waves through the medical community. Published just before the reference study “The ABCs of Cardiovascular Disease Prevention: Communicating What We Know in 2026” in the American Journal of Preventive Cardiology, the new American directive redefines the fight against “bad cholesterol”. The objective? Act before the arteries become clogged.
Screening from childhood to break the trajectory of risk
The great novelty lies in the precocity of the intervention. The guideline now recommends screening from age 9 for children with a history of familial hypercholesterolemia.
“The emphasis is placed on early detection from childhood, monitoring of lipoproteins and personalized risk assessment at 10 and 30 years old. explains Dr Gérald Kierzek, medical director of True Medical.
For Dr. Roger S. Blumenthal, president of the editorial committee, the observation is simple. “We know that reducing lipids and blood pressure in young adults supports optimal heart health throughout life.”
About 25% of adults have high LDL levels, leading to atherosclerosis. By intervening early, we prevent plaque from forming and, later, breaking off, causing a heart attack or stroke.
PREVENT: the new calculator that predicts your cardiac future
This is not the only novelty of these recommendations. The new tool, called PREVENT, is based on data from 6.6 million individuals. Unlike the old scores which started at 40 years old, this one can be used from 30 years old.
It includes new variables:
- Kidney health and blood sugar levels;
- Lipoprotein (a): a genetic factor which doubles cardiac risk if it exceeds 250 nmol/L;
- “Risk increasers”: history of preeclampsia, early menopause or inflammatory diseases such as rheumatoid arthritis.
“It is an excellent communication and teaching tool.” notes Dr. Kierzek. “Telling a patient: ‘your risk of heart attack at age 50 can drop by 20% if your LDL drops below 70 mg/dL’ is very impactful.”.
Towards lower and lower LDL cholesterol targets
The directive tightens therapeutic targets. If a level below 100 mg/dL is considered optimal for a person without pathology, the thresholds are lowered drastically for risk profiles:
- The risk is now characterized as being “intermediate”, if the level is not less than 70mg/dL;
- It is considered “high” if it is not less than 55 mg/dL.
To achieve these results, the range of treatments is expanding. Beyond statins, ezetimibe, bempedoic acid and PCSK9 injections (monoclonal antibodies) are confirmed, particularly for those who do not tolerate traditional treatments or require dual therapy.
What impact for patients in France?
If France follows its own recommendations, via the High Authority for Health (HAS) or the French Society of Cardiology (SFC), the influence of this work is major. “These American recommendations push “life-course” prevention. France is following closely and will likely expand and modify its recommendations” concludes Dr. Kierzek.
While awaiting an official update from the French authorities, the fundamentals remain the basis of prevention: 80% to 90% of cardiovascular diseases are linked to modifiable factors. A healthy diet, sleep, quitting smoking and physical activity remain your best allies, whatever your score.