New cholesterol guidelines recommend statins for an estimated 21.5 million additional U.S. adults.
The updated approach looks at a person's heart disease risk over 30 years instead of just the next 10.
Researchers say the changes could shift conversations between patients and doctors about preventing heart disease earlier in life.
If your doctor has never recommended a cholesterol-lowering medication before, that conversation could soon change.
According to a new study published in JAMA, updated U.S. cholesterol guidelines could make more than half of adults between the ages of 30 and 79 eligible for statin therapy to help prevent cardiovascular disease.
The change stems from new recommendations released earlier this year by major cardiology organizations, including the American Heart Association and American College of Cardiology. Instead of focusing primarily on a person's chance of having a heart attack or stroke within the next 10 years, the updated guidance also considers their risk over the next 30 years.
Researchers say this longer-term perspective is intended to identify people who may benefit from treatment before heart disease has a chance to develop.
“The shift to a longer view of cardiovascular disease risk is a sea change for doctors in counseling patients,” researcher Timothy S. Anderson, M.D., M.A.S., said in a news release. “We wanted to better understand the potential population-health effect of this shift.
“Before the new guidelines, people who were flagged with high cholesterol in their 30s and 40s tended to be recommended to focus on diet and exercise and were not recommended medication — unless the patient already had heart disease or other factors that made them particularly high-risk, like diabetes.”
How the researchers measured the impact
To estimate how the new guidelines would affect Americans, researchers from the University of Pittsburgh analyzed data from 4,366 participants in the National Health and Nutrition Examination Survey collected between 2017 and 2023.
Those participants represented roughly 154.5 million U.S. adults ages 30 to 79 who did not already have cardiovascular disease.
The study focused on primary prevention, meaning preventing a first heart attack or stroke rather than treating people who already have heart disease. Researchers compared who would qualify for statin therapy under the updated recommendations and found that expanding the eligible age range from 40-75 to 30-79, along with using a 30-year risk assessment, substantially increased the number of people who would be advised to consider medication. Pregnant individuals were not included in the analysis.
What the findings mean for consumers
The researchers estimated that about 87.5 million Americans — or 56.6% of adults ages 30 to 79 — would now be recommended for statin therapy. That's an increase of approximately 21.5 million people compared with previous recommendations.
Interestingly, relatively few adults in their 30s would qualify — about 11.1% — while eligibility rises sharply with age, reaching about 85% of people in their 60s and more than 93% of those in their 70s. Much of the increase comes from people who have a low short-term risk of heart attack or stroke but a higher risk over the next three decades.
The authors note that the updated guidelines represent a significant shift in how doctors and patients think about prevention. Rather than waiting until short-term risk becomes elevated, the new approach encourages conversations about whether starting a daily medication earlier in life could help reduce cardiovascular risk over the long term.
“Ultimately, in this grey zone, patients should talk to doctors,” Dr. Anderson said. This is a preference-based decision that should take into account the potential for modest cardiovascular risk reduction alongside the potential for adverse drug events, costs, and patient preferences.”