AHA now encourages cholesterol screening at 30

Heart disease is the leading cause of death in the U.S. and often develops without clear symptoms. New guidance from the American Heart Association (AHA) encourages earlier screening and a more proactive approach to prevention.

The recommendations are the first major update since 2018 and reflect a growing understanding that heart disease can begin decades before symptoms appear. Experts say earlier screening could help identify risk in younger adults who may otherwise go undiagnosed.

“These guidelines are really shifting how we evaluate patients,” says Dr. Alexandra Kharazi, a cardiothoracic surgeon with Sharp Community Medical Group and affiliated with Sharp Grossmont Hospital. “Awareness is key to prevention, and now we have better tools to identify risk earlier.”

What’s changing?

The new AHA guidance introduces several key shifts in how doctors evaluate and treat heart disease risk:

• Earlier screening: Adults are now encouraged to begin cholesterol screening at age 30. This is about a decade earlier than previous recommendations.

• A longer-term view of risk: Instead of focusing only on a 10-year window, providers are encouraged to assess heart disease risk over a lifetime to better identify younger patients at risk.

• New emphasis on additional testing: A one-time lipoprotein(a) blood test is now recommended for adults to help identify genetic risk factors.

• Earlier treatment when appropriate: In some cases, medication may be started earlier based on a patient’s overall risk.

Why earlier matters

“Cardiovascular disease is often called the silent killer because it can go undetected for many years,” Dr. Kharazi says. “Identifying risk earlier can help prevent people from reaching that stage.”

She sees this firsthand, including in patients in their 30s and 40s who may require surgery.

“Most people think of heart disease as sudden chest pain,” Dr. Kharazi says. “You clutch your chest and fall to the floor. But that really does a disservice to how cardiovascular disease can present.”

Instead, heart disease can show up in more subtle ways, especially for women and people with diabetes. Signs may include jaw pain, indigestion-like discomfort, or neck, back or shoulder pain. Women, in particular, are more likely to have atypical or no symptoms, which can delay diagnosis.

“You may be at risk sooner than you think,” Dr. Kharazi says. “That’s why it’s important to talk with your doctor and be proactive. Ask for a risk assessment.”

What you can do now

While screening and medications can help, lifestyle remains the biggest driver of heart health. “Diet, exercise and increasing activity all play an important role,” Dr. Kharazi says.

Common risk factors include:

• High blood pressure

• High cholesterol

• Smoking

• Diabetes

• Family history

Dr. Kharazi also encourages patients to speak with their doctor about their individual risk and whether additional testing, such as a lipoprotein(a) blood test, may be appropriate.

A shift toward prevention

The new recommendations reflect a broader shift toward prevention. The goal is to catch disease early and reduce the likelihood of heart attacks and strokes later in life.

For patients, that starts with a conversation.

“With this information and awareness, we can ask our doctor about testing and whether earlier treatment is needed,” Dr. Kharazi says. “It has the potential to be life-changing for many people.”

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