BALTIMORE — Updated for the first time in six years, clinical guidelines for screening and managing cholesterol now recommend earlier screenings — as young as nine years old — for those with a family history of heart disease, among other standards of care.

“Shifting the paradigm toward proactive prevention strategies earlier in life can meaningfully change the trajectory of cardiovascular disease and lead to better health outcomes for people decades later,” Johns Hopkins cardiologist Seth Martin, a member of the guideline writing committee, said in a statement on the Hopkins website.

Introduced at the American College of Cardiology’s annual Scientific Session in New Orleans on March 28, the guidelines include a new framework to help doctors calculate personalized risk assessments considering each patient’s underlying conditions. These can include a family history of congested arteries, arthritis, early menopause, and several pregnancy-related issues like preeclampsia or gestational diabetes. The guidelines also encourage shared decision-making between doctors and patients and emphasize reducing blood levels of low-density lipoproteins, or bad cholesterol, and other fats and lipids at earlier ages.

“We know that lower LDL cholesterol levels are better when it comes to reducing the risk of heart attacks, strokes and congestive heart failure,” Johns Hopkins Dr. Roger S. Blumenthal, chair of the guideline writing committee, said in the statement. “We also know that bringing elevated lipids and blood pressure down in young adults supports optimal heart and vascular health throughout a person’s life.”

The guidelines were jointly published in the Journal of the American College of Cardiology and Circulation on March 13.

They come at a time when one in 10 American adults has tested positive for high blood cholesterol, according to the Centers for Disease Control and Prevention. Specialists believe the actual number of patients suffering from high cholesterol might be one in four adults. High blood cholesterol increases the risk of narrowing or hardening of the arteries, blocking blood flow, and increasing the risk of heart attacks and strokes.

Blumenthal said 80% to 90% of a patient’s risk depends on habits that can be changed to support heart-healthy living and keep cholesterol levels within a normal range. These include eating a heart-healthy diet, engaging in regular, brisk physical activity, avoiding tobacco, getting enough sleep and maintaining a healthy weight. He said focusing on lifestyle interventions should be a first or foundational approach.

In addition to screening children with a family history of heart disease, the guideline recommends that everyone get a one-time screening for lipoprotein(a), which can reveal genetic factors that increase individual risk for heart disease by 40% or more. Additional testing can help doctors refine care for each patient.

Based on these guidelines, pregnant or lactating women, adults age 75 and older and those living with underlying conditions, such as diabetes, late-stage chronic kidney disease and HIV infection, as well as people undergoing treatment for cancer, should consult their doctor or cardiologists to ensure their best possible care, the Hopkins release states.

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