Fernandina Beach patients as young as 30 should now discuss cholesterol risk with their doctors under new national guidelines.

The American College of Cardiology (ACC), the American Heart Association (AHA) and nine other medical associations published the updated guideline on March 13, replacing the 2018 cholesterol management standard. The biggest shift: cardiovascular risk assessment now starts at age 30, a decade earlier than before.

Dr. Andrew J. Weinstein, a cardiologist at Ascension St. Vincent's Hospital in Fernandina Beach, told the Fernandina Observer that the change reflects a push toward earlier prevention. "Cardiovascular disease is something you address early in life — not waiting until you're 40 or 50," Weinstein said.

The new PREVENT risk calculator behind the change draws on data from 6.6 million people, according to Johns Hopkins Medicine. The previous calculator relied on 26,000.

A JAMA analysis published July 20 estimated the guideline makes 87.5 million U.S. adults ages 30 to 79 eligible for statin therapy. That includes 21.5 million who were not eligible under the old rules.

What the guidelines recommend

The guideline also lowers the age for initial lipid screening to 10, aimed at catching genetic conditions that cause high cholesterol early. Baseline lipid panels now start at age 19.

Every adult should get at least one lipoprotein(a), or Lp(a), blood test in their lifetime, the guideline states. Elevated Lp(a) raises the risk of heart attack and stroke.

The guidelines call for broader use of coronary artery calcium scans, a quick CT scan that measures calcified plaque. Weinstein told the Observer the scan is "probably the best screening test we have for coronary artery disease." The test typically costs about $100 out of pocket and is usually not covered by insurance.

New LDL cholesterol targets are stricter, too. The AHA said the goals are below 55 mg/dL for patients with established cardiovascular disease, below 70 for high-risk individuals and below 100 for those at borderline or intermediate risk.

New pill replaces injections

Separately, the U.S. Food and Drug Administration (FDA) approved Lipfendra, the brand name for enlicitide, on July 16. Manufactured by Merck, it is the first oral PCSK9 inhibitor, according to the American Journal of Managed Care. The once-daily pill offers an alternative to injectable PCSK9 drugs that patients had to self-administer every two weeks.

In clinical trials, the drug reduced LDL cholesterol by 56% to 59% compared with a placebo over 24 weeks, the journal reported.

Statins remain the first-line treatment.

Weinstein told the Observer that Lipfendra is meant for patients who need cholesterol reduction beyond what statins alone can achieve. Merck said Lipfendra is expected to reach pharmacies, though no specific launch date has been announced.

An ongoing outcomes trial with more than 14,500 participants is expected to report results around 2029.