For people at high risk of cardiovascular disease (CVD), more personalized risk assessments and new cholesterol-lowering treatment options are among the central recommendations in the 2018 cholesterol guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC). The guidelines also state that a lifetime approach to lowering cholesterol is the key to reducing cardiovascular risk. Among the highlights and recommendations for clinicians:

• Emphasize a heart-healthy lifestyle across the life course in all individuals.
• More detailed risk assessments can help determine a patient’s need for cholesterol-lowering treatment, if their risk status is uncertain of if treatment isn’t clear.
• Statins are still the first choice of treatment for lowering cholesterol.
• However, new treatment options for high-risk patients include a maximum intensity statin treatment, adding ezetimibe if desired low-density lipoprotein cholesterol (LDL-C) levels aren’t met, and then adding a PCSK9 inhibitor if further cholesterol reduction is needed.