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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SHEIN’s Hong Kong IPO wiped a $4.4 billion obligation from its books, but the fast-fashion giant still faces a payout of up to $3.5 billion to early investors.
3 min
Companies typically go public to raise money to supercharge growth. Fast-fashion giant Shein has another motivation.
The company’s initial public offering in Hong Kong this week is allowing it to avoid paying out billions to early investors.
If Shein hadn’t sold shares by the end of the year, the company would have been required to fork out nearly $4.4 billion in cash to holders of its convertible redeemable preferred shares. With the IPO, the $17.3 billion in preferred shares was converted to ordinary equity, and that obligation was wiped off the books.
But Shein was still on the hook for another payment. Holders of those preferred shares were entitled to a payout of billions more, in part because the company’s valuation has fallen from its peak. That payout came to nearly $3.5 billion in cash, according to regulatory filings.
The retailer on Monday priced its shares at 48.56 Hong Kong dollars each, equivalent to about $6.20 and near the middle of the range of HK$47.60 and HK$49.50 it provided last week.
The company pressed ahead with its IPO despite slowing growth and regulatory headwinds in the U.S. and European Union. Shein priced its IPO at a valuation of around $26 billion, roughly a quarter of the $98.2 billion valuation it achieved in a funding round in 2022.
Shein started selling its wares in the U.S. around 2012 and shot to popularity during the pandemic when more people shopped online. Its supply-chain prowess and vast range of styles at affordable prices made the brand a favorite among many U.S. consumers. It showed other retailers, including Amazon.com, that consumers were willing to wait more than a week for their online purchases to be delivered—if the price was right. But rivals soon emerged, such as Temu, which sells more products apart from apparel.
Shein’s business model of selling massive amounts of cheap goods lost some of its shine as more countries started imposing tariffs on small packages. The U.S. removed a trade exemption that allowed packages valued at or below $800 to enter the country duty-free, and the EU has introduced a €3 (about $3.50) customs duty on imports of low-value parcels.
Shein has worked toward its IPO for years, and the looming $4.4 billion obligation wasn’t the only reason it went public. But the threat of the big payout on Dec. 31 was certainly a part of its reason to press ahead, said Jianggan Li, founder and chief executive of Momentum Works, a research advisory firm based in Singapore.
“Complete the listing before then,” said Li, “and a very large liability comes off the balance sheet.”
While that liability will now be off its books with a successful IPO, Shein said it was saddled with another bill: the roughly $3.5 billion it owed its early investors upon going public.
That amount includes $1.3 billion that Shein had to pay several late-stage pre-IPO investors who had been guaranteed a cash payout at an 8% or 12% annual return, and up to $2.2 billion in compensation for the fall in the company’s valuation in the period after they made their investments. The $2.2 billion was a projection based on the lower end of the offer price range, or HK$47.60 per share, so the total bill will likely be smaller than $3.5 billion. The exact amount has yet to be disclosed by the company.
Notably, the amount it owes investors is more than the roughly $1.7 billion the company raised in the IPO. The company said it was paying the funds to its investors out of cash it has on hand.
The investors entitled to the payments include entities linked to HSG, formerly known as Sequoia China, Boyu Capital, Tiger Global, General Atlantic, Thrive Capital and others.
“What the IPO really does here is resolve the capital-structure overhang,” Li said. “It gives investors liquidity, terminates those preferred-share rights and cleans up obligations created when Shein raised money at much higher valuations.”
Shein could have kicked the can down the road by renegotiating terms with its investors, he said: “Shein is not taking the cheapest way out of its old financing obligations. It is taking the cleaner way out.”
