How Early Should You Check Your Cholesterol?

Summary

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Podcast Summary: Chasing Life

Episode: How Early Should You Check Your Cholesterol?
Host: Dr. Sanjay Gupta, CNN Podcasts
Date: March 24, 2026

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Main Theme & Purpose

This episode responds to listener questions about newly released cholesterol guidelines that recommend earlier screening for cardiovascular risk. Dr. Sanjay Gupta unpacks what’s changed, who should be concerned, and why these recommendations matter. The episode addresses confusion around statin use, explains the new role of lipoprotein(a) testing, clarifies statin side effects, and provides actionable advice on lifelong cholesterol management.

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Key Discussion Points & Insights

1. New Cholesterol Guidelines: Earlier and Broader Screening

Timestamp: 02:47–05:48

• Major Shift: Screening and possible treatment now recommended starting at age 30, ten years earlier than before.
• Risk Calculation: Instead of only estimating your 10-year risk for heart events, new guidance emphasizes 30-year or lifetime risk.
• Key Cholesterol Marker: Focus remains on LDL (“bad” cholesterol). If LDL is 160 mg/dL or higher, or if you have a strong family history of premature heart disease, earlier intervention may be necessary.

Dr. Sanjay Gupta:

“Instead of waiting until 40, the recommendation is to start thinking about screening, and in some cases, treatment beginning around age 30. So everything frame shifts 10 years earlier.” (03:26)

• First Cholesterol Check:
  • Ages 9–11: Initial comprehensive cholesterol screening
  • Again at 19, then every five years thereafter
  • At 30: Full check and risk calculation via an online “prevent calculator”
• Not Everyone Needs Medication:
  • Turning 30 doesn’t mean automatic statin use; it means more people may need to discuss risks and options with their doctors.
  • Lifestyle changes are still vital and may be appropriate for the majority.

2. The Role of Lipoprotein(a), or “Lp(a)”

Timestamp: 05:48–08:19

• What is Lp(a)?:
  • A cholesterol particle, stickier than LDL, increasing plaque buildup risk.
  • Highly Genetic: Diet and exercise don’t change it; levels are static throughout life.

Dr. Sanjay Gupta:

“This may be the most important thing you learned overall from these guidelines… Lifestyle factors aren’t going to change Lp(a)...which means you probably only need to get it checked once in your life.” (06:07–06:39)

• Testing Recommendations:
  • Only need this test once because it’s determined by your genes.
  • 20% of U.S. adults have elevated Lp(a).
• Impact on Treatment:
  • High Lp(a) might push for more aggressive lowering of other cholesterol numbers.
  • Statins and lifestyle changes don’t lower Lp(a).
  • New medications are being studied, but none are widely available yet.

3. Statin Side Effects: What’s Real and What’s Not

Timestamp: 09:32–12:05

• Common Concern: With earlier and expanded statin use, concerns about side effects increase.
• Most Common Side Effect: Muscle pain or aches (occurs in 5–10% of users).
• Other Side Effects:
  • Elevated blood sugar/insulin resistance (can tip some into diabetes; <1% risk).
  • Liver and kidney function: Changes possible but rare (<1% risk).
  • Side effects such as “changes in liver function” are monitored with regular blood tests when starting statins.

Dr. Sanjay Gupta:

“In clinical trials, the percent of people who experience [muscle pain] is relatively small—between 5 and 10%. Sometimes that muscle pain can be significant enough that people actually want to stop taking the medication.” (09:55)

• Lancet Study Cited:

  • Of 66 reported side effects, only four were proven: muscle pain, raised blood sugar, liver enzyme changes, kidney changes; all others were artifact.

• Best Practices:

  • Doctors check liver function before and during use.
  • Statin use is monitored, and side effects are closely watched.

4. Do You Need to Stay on Statins Forever?

Timestamp: 12:19–14:55

• Lifestyle is Still Key:
  • “Even if you start taking statins, you should still be implementing lifestyle changes.” (12:29)
• Long-Term Use:
  • Most people prescribed statins—either for primary (preventing the first event) or secondary (preventing recurrence after a heart attack/stroke) prevention—remain on them for life.
  • Only about 1 in 77 can successfully stop statins if levels stay low off medication.

Dr. Sanjay Gupta:

“Will you have to be on a statin for the rest of your life? The short answer is, typically most patients are…The vast majority of those people will be on these medications for the rest of their life.” (12:36–13:10)

5. Actionable Takeaways

Timestamp: 14:35–14:55

• Heart disease is still the leading killer in the U.S. for both men and women.
• **Everyone should:
  • Know their cholesterol numbers from early age.
  • Have Lp(a) tested once in their life.
  • Recognize that not everyone will need a statin, but conversations should start earlier with healthcare providers.
  • Maintain lifestyle changes regardless of medication use.

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Memorable Quotes & Moments

• On earlier screening:

  “A lot of people just don’t simply know their numbers at all. And you want to be thinking about these numbers as early in life as possible.” (04:53)

• On Lp(a):

  “There are specific drugs that are being investigated nowadays to try and lower Lp(a), but they’re not out as of yet.” (07:54)

• On side effects:

  “When they do that, they find that there were four things that were real. Other things were more artifacts.” (10:30)

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Timestamps for Important Segments

• 02:47 | Dr. Gupta explains the new cholesterol guidelines and earlier screening
• 05:48 | Lp(a): what it is and why test for it
• 09:32 | Statin side effects: frequency and facts
• 12:19 | Do you need statins for life? Who can stop?
• 14:35 | Key takeaways and closing advice

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Conclusion

Dr. Sanjay Gupta makes sense of new cholesterol screening guidelines, highlighting a generational shift toward earlier, more comprehensive prevention. He unpacks the role of emerging risk factors like Lp(a), clarifies common misconceptions around statin safety, and grounds his advice in the importance of knowing your numbers and prioritizing lifestyle. The episode is filled with actionable advice and real listener stories, demystifying what it means to “chase life” and proactive health in 2026.

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Transcript

[A]

Hey there. Welcome to Paging Dr. Gupta. Thank you so much for joining us. As you hopefully know by now, this is the show where we dig into the questions that you are sending in, that you are writing in from all over the country, frankly, all over the world. And these episodes are some of my favorites because I get to hear from you, I get to hear your questions. But so many of you share your stories as well, which I really appreciate, and things that you're trying to make sense of. And with that, our producer Kira is back with us. What do we have first?

[B]

Hey, Sanjay. Okay, so first up, I'm actually going to be asking one of my own questions. So I just saw these new cholesterol guidelines that came out and we're hearing that millions more people could be told to start treatment earlier, like in their 30s. I'm almost 30, so I had a mildly alarming thought like, am I already supposed to be thinking about statins? I think a lot of people assume high cholesterol is something that you worry about later in life, but now we're hearing something a little bit different. So, Sanjay, what are these new recommendations actually telling us?

[A]

Okay, Kira. Well, first of all, I think a lot of people had the exact same reaction. I've been talking to people around the country, but also people in my own hospital, doctors trying to make sense of all this. And they and I think the headline here is don't panic. These new recommendations are about catching risk earlier, before bad cholesterol has had years and years to build up in your arteries. So after the break, we're going to talk about what has actually changed and who really needs to pay attention. Stay with us.

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[A]

All Right. So new guidelines, 123 pages of new guidelines which I have read. And I want to give you some of the headlines first and then dig a little bit into it in terms of trying to make sense of it for you. For years, a lot of cholesterol decisions were based on a 10 year risk of having some sort of heart problem or a stroke. Okay. So typically around age 40, people would really start to dive into these risk factors and they would ask the question, what does the next 10 years look like for you? What is your risk over the next 10 years? What these new guidelines do is push that conversation earlier. So instead of waiting until 40, the recommendation is to start thinking about screening and in some cases, treatment beginning around age 30. So everything frame shifts 10 years earlier. And also instead of thinking about just the next 10 years, thinking about 30 year risk or even lifetime risk. And the idea is that Even if your 10 year risk was low, if you have high levels of bad cholesterol and your body is increasingly exposed to that high cholesterol, that can be a problem. That can be an opportunity for plaque to build up in your arteries and potentially cause problems later on. When I have to summarize these guidelines, what they're really saying is that an ldl, that's low density lipoprotein, that's the bad cholesterol if it's 160 or higher, if you have a strong family history of premature heart disease and you have a high long term cardiovascular risk. So, first of all, turning 30 does not mean everyone suddenly needs a statin. That's not what they're saying. But it might mean that millions more people who previously were not on medications might be getting a recommendation from their doctors about potentially taking one. But overall, I think the biggest headline here is to think about screening. A lot of people just don't simply know their numbers at all. And you want to be thinking about these numbers as early in life as possible. How early? Well, according to these guidelines, they're saying between the ages of 9 and 11. So 9 years old to 11 years old, that is the first time you should probably get at least one comprehensive screening of your cholesterol and your lipids. Then again at age 19, right. As you come out of adolescence, and every five years after that, and then at age 30, getting all these numbers checked, but also calculating your risk based on something known as a prevent calculator, which you can find for free online. And that's going to give you a good sense really now of what your risk is over the next 30 years to the rest of your life. Again, not everyone's going to need a statin by any means. Lifestyle changes might still be the right answer for the majority of people, but this is something to start thinking about earlier. Now, as I mentioned, a lot of questions coming in on this. Kira, what do we have next?

[B]

All right, next up is Juan in Florida, who wants to know, will doctors begin to incorporate testing LP levels for their patients?

[A]

All right, I'm so glad. This question about lp, lipoprotein A or lp, that's the way it's often referred to. I'm so glad there's questions coming in about this, because this is really important. This may be the most important thing you learned overall from these guidelines, because a lot of people know cholesterol, they know bad cholesterol, they know triglycerides. But you may have never heard of lp. It's a cholesterol particle. It's similar to LDL cholesterol or the bad cholesterol. But LP is stickier. Okay, think about it being stickier and something that's able to build up in arteries and increase your risk of having some sort of heart problem. But here's the really interesting thing about lp. It's largely genetic. That means it's fixed. That means that lifestyle factors like exercise and diet or lack of exercise and diet won't really change lp. It's pretty static, which means you probably only need to get it checked once in your life. It's not really going to change over your life. So why do you want to test for it? And about 20% of the adult population in the United States has elevated levels. If you have high levels of this, that might push you to reducing your other cholesterol levels even more. So let's say you're sort of borderline with regard to your bad cholesterol, but you have a high lp. Your doctors are more likely to be aggressive in terms of lowering your cholesterol. Now, if you have a low LP in your borderline, the doctors may say, hey, look, let's try lifestyle changes more aggressively and see if we can avoid taking a statin. But one thing to keep in mind, statins as well as lifestyle changes, they're not going to lower your lp. Again, that is largely genetic. That is largely fixed. There are specific drugs that are being investigated nowadays to try and lower lp, but they're not out as of yet. All right, Now, a lot of people hear statin, and they immediately understandably worry about side effects coming up. We'll get into what is real what is rare and what you should actually know. That's after the break.

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[A]

All right, I hear the pager again. Kira, who do we have next?

[B]

Okay, Sanjay, we have Ryan from California asking how common do each of the side effects from statins occur?

[A]

All right, common side effects from statins. First of all, let me just dial back for a second and talk about this whole concept philosophically. If you think about the fact that we're going to be screening earlier and potentially putting people on statins earlier, that's a concern, right? That means a lot more people may be getting medicated. A lot of people will stay on those medications for a long time, if not their entire life. And I just think as a society, we always need to be judicious about adding more and more medications to the mix. Now, in terms of specific side effects, the most reported side effect is muscle pain, muscle aches. Now, in clinical trials, the percent of people who experience this relatively small between 5 and 10%, sometimes that muscle pain can be significant enough that people actually want to stop taking the medication. They simply can't tolerate it. Increasing your blood sugar, that's another known side effect. And part of the issue here is that statins seem to make you insulin resistant. So your insulin, which lowers your blood sugar, is not working as well. So insulin resistance leads to hyperglycemia, high blood sugar, and in some cases could tip people over into diabetes. Less than a 1% chance of that happening. I will tell you just something in general about side effects. People report different possible side effects. All those are looked at. There was a great article about this in The Lancet. So there were 66 possible side effects that were reported from people who started statins. They take a look at those side effects. They compare that to the general population of statin users and the general population overall. And when they do that, they find that there were four things that were real. Other things were more artifacts. The four things that were real, again, muscle pain. We talked about hyperglycemia, elevated blood sugar, and then changes in liver function and kidney function. But beyond the muscle pain, the risk of the other things was pretty low. Again, less than 1%. When you start statins, your doctor will likely say, hey, before you actually start taking the medication, let's check your liver function for those liver enzymes. And then again, a few months into taking the statins, they'll probably want to check again, even though the risk is low of having some sort of liver problem. That's an easy test to perform to make sure your liver is not taking a hit from these new medications. Okay, Kara, time for one more question.

[B]

So, last up, we have Takbur, who takes a statin, and he says he follows his doctor's advice on exercise and diet, but wants to know if he will need to use it for the rest of his life or until bringing the cholesterol to lower limits.

[A]

Well, first of all, Takbir, I just want to say that lifestyle changes, diet, and exercise are still going to be the gold standard in terms of the advice you're going to get. It's not going to help with LP that is largely genetic, but lifestyle changes, exercise, and diet can make a difference for a significant percentage of people who are trying to lower their cholesterol. And even if you start taking statins, you should still be implementing lifestyle changes. So, question, will you have to be on a statin for the rest of your life? The short answer is, typically most patients are, especially those who are taking statins to reduce the likelihood of having another heart attack or stroke. So that means this is secondary prevention. They've already had a heart attack, and now they're taking statins to prevent a second heart attack. That secondary prevention population, most of those people stay on statins for their whole life. There's another group of patients who are using it for primary prevention, which means they've never had a heart attack or stroke. They're now using the statin to prevent that from happening in the first place. And again, the vast majority of those people will be on these medications for the rest of their life. When I looked up the most recent data, they found that about 1 in 77 people are able to come off the statins, and in those cases, it's because their cholesterol levels go low and they stay low even when the statins are removed. So there you have it, new guidelines for heart disease. And keep in mind, heart disease is still the biggest killer of Americans, men and women alike. So this is a big deal. I think one of the headlines you should take away from this is LP lipoprotein A. Maybe something you've never had checked, get it checked. You only have to have it checked once because it is genetic. It's not likely to change. But that can influence a lot of the other decisions we've talked about today. And that is a wrap for today's episode. Thank you so much to everyone who sent in the questions. This show would not exist without you, and I'm glad you're part of it. No question is too big or small. No question is embarrassing. We might just answer whatever's on your mind in our next show. Record a voice memo. Email it to paging Dr. Gupta at CNN.com that's paging Dr. Gupta.com or give us a call 470-396-0832 and leave a message. Thanks so much for listening. What's up?

[G]

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