New guidance from the American Heart Association puts a sharper focus on cholesterol earlier in life. It says healthy lifestyle counseling should start in youth, and that cholesterol medication should be considered earlier for some patients, including young people with a strong family history of premature heart disease, those with familial hypercholesterolemia (a genetic condition that causes very high cholesterol levels to run in families) and young adults with LDL cholesterol of 160 mg/dL or higher.
As a young primary care physician in Arizona, I understand why this can feel like something to think about later. Many people in their 20s and 30s feel fine and have plenty of other things competing for their attention. But the guidance makes an important point: the longer someone lives with high LDL cholesterol, the more that exposure can raise the risk of atherosclerotic cardiovascular disease over time.
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That is the real shift. Young people should not be overlooked. Some patients may need closer follow-up, stronger lifestyle counseling or, in selected cases, treatment for high cholesterol earlier than many people might expect.
The most practical first step is simply knowing your numbers. The Centers for Disease Control and Prevention says most healthy adults should have their cholesterol checked every four to six years. People with a family history of high cholesterol may need to be tested more often. The AHA guideline also recommends screening with a lipid profile beginning at age 19 and repeating it at least every five years to identify treatable risk, with more frequent screening for people with additional risk factors.
Another reason not to put this off is that high cholesterol usually does not cause symptoms. The CDC says there are usually no signs or symptoms, which means many people do not know they have it until it shows up on a blood test.
The conversation with a doctor should focus on practical next steps. Ask what your cholesterol numbers mean. Ask how often you should be checked. Ask whether your family history means you may need testing more often. These are not alarmist questions. They are smart, preventive ones.
The advice I give patients is not complicated, but it does matter. Eat more fiber, fruits, vegetables, beans and whole grains, and cut back on processed foods, saturated fats, sodium and added sugar. Aim for at least 150 minutes of moderate aerobic activity a week, such as brisk walking. If you smoke, quitting is one of the most important steps you can take for your heart health because smoking is one of the factors that can contribute to high cholesterol and cardiovascular risk.
Family history deserves special attention. The American Heart Association notes that some people have a genetic predisposition to very high LDL cholesterol called familial hypercholesterolemia. The guideline specifically highlights strong family history of premature atherosclerotic cardiovascular disease as a reason to think about risk earlier in young adulthood. That is why family history is not just background information. It can change the conversation.
The bottom line is that younger people should not assume they are too young to start the conversation. The updated guidance makes clear that earlier screening, earlier risk assessment and earlier action matter, especially for people with higher LDL cholesterol or a strong family history of early heart disease.
Dr. Saman Manzouri is a primary care physician with Optum Arizona.
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