New medical guidelines aim to head off damage early with lifestyle changes, screening tests and medication.
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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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AI-powered travel agents are challenging online booking platforms, but Airbnb’s exclusive listings and direct customer relationships could give it an edge. Its next challenge: turning repeat guests into loyal customers through stronger rewards and innovation.
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AI agents like Muse can already find you the cheapest hotel room in Paris. But they can’t locate a cheaper version of that Catskills cabin you’ve been eyeing, because it might only be available on Airbnb ABNB -1.43%decrease.
Investors should pay attention to that distinction. When Meta Platforms META 3.38%increase launched its Muse agent last month, travel stocks including Booking Holdings BKNG -1.19%decrease, Expedia and Airbnb all fell sharply.
Airbnb, though, has a real chance to emerge as a winner from the upheaval. The catch: Its stock already reflects above-industry growth. To justify its valuation, Airbnb will need to turn repeat customers into loyal ones.
Online travel companies make much of their money by simplifying search and collecting fees on bookings. AI agents threaten that model.
But not all travel marketplaces are equally exposed. Booking and Expedia largely sell hotel rooms that travelers can also book directly or through competing sites. If an agent can find the same room elsewhere, it has little reason to favor either Booking or Expedia.
Booking and Expedia also sell sponsored listings that steer travelers toward particular properties. Wells Fargo estimates those will account for about 8% of Expedia’s revenue and a much higher percentage of profit next year.
Airbnb has more ways to adapt. More than half its listings are available only on its platform, and more than 90% of its traffic comes directly to its app or website.
The customer relationship doesn’t end after booking, either. Bernstein analyst Richard Clarke notes that 90% of Airbnb guests go on to message their hosts about arrival times, keys or local taxes, giving Airbnb a connection to both sides of the transaction.
How the companies have responded to the possible agentic future is telling.
Expedia quickly signed on as a Muse partner. Airbnb hasn’t, and Chief Executive Brian Chesky says AI chatbots have so far been a boon, sending customers to Airbnb’s website.
Chatbots might work for buying paper towels, he quipped at a Skift conference last month, but people enjoy planning trips. He argued that browsing dozens of homes isn’t something a text-based chatbot is well suited for.
Still, the AI jitters arrived just as Airbnb was persuading investors it deserved its pricey multiple. For years after its 2020 initial public offering, the stock—which trades around 25 to 30 times forward earnings—went nowhere. Investors saw a mature operator trading at a growth premium.
This year, Airbnb growth seems to be accelerating. The stock jumped in August after the company raised its full-year revenue-growth guidance with its second-quarter results. Wells Fargo analyst Ken Gawrelski credits a run of product improvements under a revamped leadership team.
Among the changes: letting guests reserve now and pay later, adding hotels, and a redesigned home page and app. Investors were also betting on what comes next, including thousands more hotels, car rentals and, eventually, advertising.
The irony is that some of those growth drivers push Airbnb closer to the kind of business Booking and Expedia run—the kind of business AI agents could threaten. Even if AI agents capture a large share of travel planning and booking, Airbnb would capture the demand. But it and others would slowly lose control over how customers find and choose properties.
That would undermine the advertising opportunity investors are counting on. The bigger point for Airbnb and other marketplaces is that losing control of customer acquisition could mean surrendering some of their pricing power and margins.
To bulletproof itself, Airbnb might look to another e-commerce giant that has so far kept AI agents at arm’s length: Amazon.
Like Amazon, Airbnb has a loyal customer base and hard-to-match supply. But it has nothing like Prime membership to make customers think twice before taking their business elsewhere.
That is where loyalty comes in. Business travelers stick with Hilton or Marriott because enough nights earn them perks. Leisure travelers rarely accumulate stays with one chain. Airbnb has millions of listings and plenty of repeat customers, but no broad rewards program. It has begun experimenting with credits on hotel stays, but it should make loyalty a priority, not just a promotion.
Airbnb also plans to launch its own AI agent next year. But travelers using an agent might still want it to search Airbnb, Vrbo, Booking and hotel websites alike, rather than limit itself to one company’s inventory.
Eventually, Airbnb might have to strike deals with agent makers, using its unique homes as leverage to negotiate favorable terms, says Gawrelski. Such deals, along with rewards for loyal guests, could over the long term eat into the company’s roughly 13% take rate, he adds. But if they bring in enough additional bookings, the trade-off could be worthwhile.
History offers a reason not to panic. The shift from desktop to mobile unsettled investors in Alphabet and Amazon, but both emerged as major beneficiaries. Companies with valuable assets can come out of a platform shift stronger, if they adapt quickly enough.
Airbnb has homes the bots can’t easily replace. Now it needs to give guests a reason to insist on booking them there.
