New Cholesterol Guidelines Recommend 3 Tests to Better Predict Heart Disease Risk

The updated guidelines from the American Heart Association and American College of Cardiology include recommendations for apoB, lipoprotein(a), and coronary artery calcium screenings.

Mar. 16, 2026 at 8:08pm

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The American Heart Association and American College of Cardiology have updated their cholesterol management guidelines, recommending three additional screening tests beyond standard LDL and HDL cholesterol measurements: apolipoprotein B (apoB), lipoprotein(a) (Lp(a)), and coronary artery calcium (CAC) scans. These tests can help identify hidden cardiovascular risk factors that standard cholesterol tests may miss.

Why it matters

The new guidelines aim to improve how healthcare providers assess cardiovascular disease risk. The recommended tests can provide independent and important information about a patient's risk, allowing clinicians to offer more targeted treatment. This is especially important for people with conditions like type 2 diabetes or cardiovascular-kidney-metabolic syndrome, where standard cholesterol tests may not fully capture their risk.

The details

The apoB test measures a protein attached to LDL that can cause plaque buildup, offering a more precise count of harmful cholesterol particles. Lp(a) is a type of LDL that is more likely to contribute to plaque, and high levels are largely determined by genetics. The CAC scan uses a CT scan to detect calcium deposits in the arteries, revealing early plaque buildup and estimating future heart disease risk. These tests are sometimes covered by insurance, but can also cost between $50-$250 out-of-pocket.

  • The American Heart Association and American College of Cardiology released the updated cholesterol guidelines in March 2026.

The players

Carl E. Orringer, MD

A writing committee member of the 2026 cholesterol guidelines and the director of preventive cardiology at Naples Comprehensive Health Care System in Florida.

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What they’re saying

“Studies have shown that cardiovascular events associated with the lipoprotein dysregulation characterizing [cardiometabolic] disorders are inadequately predicted by LDL-C.”

— Carl E. Orringer, MD, Writing committee member of the 2026 guidelines, Director of Preventive Cardiology at Naples Comprehensive Health Care System

“If the clinician wants to know if the patient is being treated in the most complete manner to reduce their atherogenic particle-related risk, apoB is the best test to order.”

— Carl E. Orringer, MD, Writing committee member of the 2026 guidelines, Director of Preventive Cardiology at Naples Comprehensive Health Care System

“We now know that 20% of the population has high levels of Lp(a), placing them at increased risk for both atherosclerotic cardiovascular disease and aortic valve stenosis.”

— Carl E. Orringer, MD, Writing committee member of the 2026 guidelines, Director of Preventive Cardiology at Naples Comprehensive Health Care System

“CAC has been shown to be highly predictive of future cardiovascular disease events, and there is increasing evidence that those with severely elevated levels have a risk as high as that of very high-risk individuals with established cardiovascular disease.”

— Carl E. Orringer, MD, Writing committee member of the 2026 guidelines, Director of Preventive Cardiology at Naples Comprehensive Health Care System

What’s next

Healthcare providers may recommend one or more of the new screening tests during a patient's next annual physical. Depending on the patient's family history, age, and health status, they may benefit from apoB, Lp(a), and/or CAC testing to get a more complete picture of their cardiovascular risk.

The takeaway

The updated cholesterol guidelines provide clinicians with additional tools to better assess and manage their patients' heart disease risk. By incorporating these new screening tests, healthcare providers can identify hidden risk factors and offer more personalized, targeted treatment to help prevent future cardiovascular events.