New medical guidelines aim to head off damage early with lifestyle changes, screening tests and medication.
3 min
Adults should be screened and treated for high cholesterol starting at age 30, if not sooner, according to new clinical guidelines, lowering the age by at least a decade at a time when heart attacks are becoming more common in younger adults.
The goal is to shift to a more proactive approach to head off problems in younger years, rather than starting lifestyle changes and medical treatment in middle age when a patient may already have damage in their arteries, said Dr Roger Blumenthal, chair of the committee of cardiologists that wrote the new guidelines.
Growing research shows how much damage can be done when levels of LDL, or “bad,” cholesterol stay high in the blood for years, he said.
At the same time, more medicines have become available to lower cholesterol, along with screening tests and a new online tool that allows people 30 and older to calculate their risk of cardiovascular disease.
“We need to pay attention much earlier,” said Blumenthal, director of preventive cardiology at Johns Hopkins Medicine.
The guidelines, published Friday in two leading cardiology journals, were issued by 11 medical associations, including the American College of Cardiology and American Heart Association.
These organisations set standards for medical professionals from family doctors to cardiologists.
Approximately 25% of U.S. adults—and 20% of adolescents—have high LDL cholesterol.
For adults, especially, that increases their risk of heart attacks and strokes because it causes plaque-forming particles to build up in their arteries over time, hardening and narrowing them.
Doctors are being urged to counsel children and adolescents on diet and exercise, avoiding tobacco and other healthy lifestyle habits.
More young people are being diagnosed with diabetes and other conditions that put them at higher risk of cardiovascular events.
“If we want to talk about eliminating heart disease and heart attacks, treating cholesterol is one of the most important things,” said Dr Sadiya Khan, professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine. She wasn’t involved in writing the recommendations.
The new guidelines offer a number of different ways doctors can determine whether a person’s at risk.
Everyone should get a blood test once to measure their levels of lipoprotein(a), another type of “bad” cholesterol linked to heart disease.
Researchers say Lp(a), which is genetic, significantly increases the risk of cardiovascular disease, and a test can identify risks for people who are otherwise healthy.
Testing for another protein, apolipoprotein B, can also be performed for those with high triglycerides, diabetes or other conditions, the guidelines say.
Research suggests it is a better predictor of heart disease risk than LDL cholesterol. undefined undefined Men aged 40 and older and women aged 45 and older with a borderline risk of heart attack or stroke may also get a coronary artery calcium scan to check for plaque buildup in arterial walls.
Children should be screened for cholesterol and other lipids once between ages 9 and 11, backing an existing recommendation by the American Academy of Pediatrics.
As part of the new guidelines, young adults should be screened beginning at age 19 and every five years after that.
People should be screened for their risk of cardiovascular disease starting at age 30, using an AHA online calculator called
Prevent that measures risk based on a person’s cholesterol, blood pressure, and other indicators. Screening was previously recommended beginning at age 40, using a different tool.
Young adults should be offered cholesterol-lowering medications if their LDL cholesterol is 160 milligrams per deciliter, according to the guidelines.
The same is true if they have a family history of atherosclerotic disease at an early age or a high risk of developing it over the next three decades as measured by the Prevent calculator.
Adults with genetically high cholesterol should also be put on medication. undefined undefined
While the end result of additional screening may mean more people end up on cholesterol-lowering drugs, younger people may be able to avoid high doses.
“If you identify someone at risk earlier in life, you may not need to treat them with as intensive a statin regimen because you have time on your side,” said Dr Steven Nissen, a preventive cardiologist at the Cleveland Clinic, who wasn’t involved in writing the new guidelines.
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Apple’s first foldable, the $1,999 iPhone Duo, combines an iPhone and iPad Mini experience—but its size, weight and price come with compromises.
4 min
As I watched a Netflix show on Apple’s first foldable, the iPhone Duo, I had two surprising thoughts.
The first: Maybe I don’t need my iPad Mini anymore.
The second: Uh oh, am I about to spend $1,999 on a phone?
I didn’t think folding phones were for me. I’ve been testing Android versions from Samsung and Google since 2019, and those early editions came with too much screen and too many compromises.
Fast forward seven years, and the technology has come a long way. Apple—in its very Apple way—has also come up with some hardware and software trickery to make up for some shortcomings of the basic design. My desire for a folding phone before today was zero. After today, it’s a lot more than zero.
I’m not ready to recommend the Duo, which ships on Oct. 23, just yet. Not until I am able to test it more fully, so be on the lookout for that review in a few weeks. But from what I experienced at Apple Park on Wednesday, I could actually picture myself using this new half-phone, half-tablet hybrid.
For months, I’ve been using Samsung’s Galaxy Z Fold 8, a similarly squat, passport-shaped foldable that opens up to a larger screen. It’s impressively thin and can easily fit into the infuriatingly tiny pockets in women’s pants and dresses. Samsung did a lot of work to minimize the crease—the dip between the two halves of the big interior display—but it’s still clearly there.
When I held the iPhone Duo open, the crease was barely visible. As I slid my finger across the display, I could feel it, but it’s more subtle than Samsung’s. Most of the time, the screen looked as flat and smooth as the one on an iPad.
Apple employed both software and hardware techniques to camouflage the crease. The matte surface of the interior 7.6-inch screen minimizes reflections to hide it. (Samsung’s Fold 8 screen is shiny.)
And as you begin to open or close the iPhone Duo, the interface shifts the controls and content away from the center crease. If, say, you’re watching a video on the outer screen, you can open the Duo to switch to the bigger display within. A black fade marks the transition. You don’t see the video full screen until the phone is completely flat.
My second observation was that, when the Duo is closed, in phone mode, it was harder to use one-handed than I expected.
In the keynote trailer and press release, Apple touted how thin the Duo is. It’s marketed as the thinnest iPhone ever—when open.
But it’s actually thicker and heavier than most of its Android competitors. The Duo weighs 254 grams, and is 11.3 millimeters thick when closed. The Samsung Galaxy Fold 8 is just 201 grams, with a thickness of 9.7 millimeters. Google’s Pixel 11 Pro Fold is 239 grams and 10.1 millimeters.
Because the Duo is also wider than a standard iPhone, I found it quite a challenge to type.
I admit, I do have smaller-than-average hands. So I consulted my colleague Rolfe Winkler, who has a larger grip. He agreed the Duo feels big.
Apple rearranged the interface on the outer screen so it looks different than traditional iPhones. The dock and control center are off to the right to be more reachable. Committing to the Duo as your main device will require adjustments in your handling. You will have to learn a new way to use and type.
My most surprising takeaway? I feel a pull toward this device.
I always thought that combining an iPhone and an iPad would mean bigger compromises. The battery life is about the same as the 18 Pro (up to 24 hours of “regular use” on a single charge), though I’ll need to verify that in my real-world testing. And it’s also as durable, with the same IP68 dust- and water-resistance rating as the rest of the iPhone lineup.
There are trade-offs, for sure. Trying out the camera, I immediately missed the 8X zoom in my Pro model. The Duo has just 2X zoom, which wouldn’t cut it for the dozens of pictures I take of my kid every day.
But the dual screens unlock new photo functionality. You can see what your shot looks like from the outside screen. As someone who has tried tirelessly to self-direct a family photo—or a spouse—I am very eager to try this out more.
Foldables, I initially thought, were for classic mobile-warrior jet-setter types, who never sit at a desk and are always on calls. For that crowd, the Duo can run two apps side-by-side.
Me, I’m more of a bed binge-watcher and ebook reader. That’s what my beloved iPad Mini is for.
Watching videos on the Duo is a nice experience—nice enough that you forget the screen is 0.7 inches smaller than the iPad Mini’s. The main screen is also a 4:3 aspect ratio. Very similar, by the way, to the IMAX edition of the Odyssey.
Because I wasn’t able to snag a ticket to one of the sold-out screenings, I will be watching Christopher Nolan’s version of Homer’s epic on the Duo, just as the director intended. (Just kidding! Sort of.)
The Duo costs $800 more than an iPhone 18 Pro, and I’m not sure I want to spend that premium on a first-generation Apple device. But I’m not ruling out the idea that a Duo might one day be in my future. Stay tuned for my full review.
