Cholesterol levels are dropping among Americans. And more people at especially high risk are getting treatment. Researchers suggest a controversial change in recommendations for cholesterol treatment may be starting to pay off. Lead author Dr. Pankaj Arora from the University of Alabama says the results are “heartening” but there’s more to do.

Heart disease is the world’s leading killer and high cholesterol is a key risk factor but not the only one. Doctors long treated patients based mostly on their level of so-called bad cholesterol, whether they had other risks or not. But in 2013, the guidelines urged doctors to instead focus on people’s overall health risk, by taking into account age, blood pressure, diabetes and other factors. Those at highest risk would get the most benefit from cholesterol-lowering statin drugs. Among people taking cholesterol medication, the average level of bad cholesterol, or LDL, dropped 21 points. The study is published in Journal of the American College of Cardiology.