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High Cholesterol Treatment Guidelines Based on Heart Attack Risk

Topic Overview

New treatment guidelines

In the coming months, doctors will shift how they treat high cholesterol. This change is based on new cholesterol treatment guidelines from the American College of Cardiology and the American Heart Association. Your doctor will consider your overall health in recommending treatment. The goal is to lower your risk of a heart attack or stroke, not to reach a certain cholesterol number. It is important to talk to your doctor at your next visit about what your risk is and what treatment is best for you.

This topic will be updated soon with the new guidelines.

Previous guidelines

If you have high cholesterol, you need treatment to lower your risk of heart attack and stroke. The two main treatments are lifestyle changes and medicine. The treatment that is right for you depends on your risk for having a heart attack.

Your doctor will use your health and family history to check your risk of a heart attack. You can find your risk by using the Interactive Tool: Are You at Risk for a Heart Attack? Use the percentage you get from the tool to find your risk category in the table below:

Your Risk Category
Risk category Risk of a heart attack within 10 years
Highest (category I) More than 20%
Moderately high (category II) 10% to 20%
Moderate (category III) Less than 10%
Lower (category IV) No coronary artery disease; 1 or 0 risk factors

Recommended treatments1, 2

Highest risk (Category I)

Keep LDL at less than 100.

Your doctor may want your goal to be lower, less than 70, based on your risk factors. Getting your cholesterol to less than 100, or less than 70, means:

  • Making changes in what you eat.
  • Getting more exercise.
  • Taking medicine, especially if you have coronary artery disease or other risk factors and need to get your LDL to less than 70.

You also may want to talk to your doctor about taking a low-dose aspirin each day. It may help reduce your risk of heart attack.

Even if you are taking medicines, a healthy lifestyle will help lower your risk of a heart attack. If you need to make healthy changes, a good place to start is the Therapeutic Lifestyle Changes (TLC) program. The program will help you eat better, exercise more, and lose weight if you need to. When you start to make these changes part of your daily life, you will be on the way to reducing your risk of heart disease and stroke.

Moderately high risk or moderate risk (Category II or III)

Keep LDL at less than 130.

Getting your cholesterol to this level means:

  • Making changes in what you eat.
  • Getting more exercise.

You may have to take medicine too.

Check out the Therapeutic Lifestyle Changes (TLC) program. It can help you lower your cholesterol and your risk of heart disease and stroke.

Lower risk (Category IV)

Keep LDL at less than 160.

Starting on the Therapeutic Lifestyle Changes (TLC) program can help you keep your cholesterol low, along with your risk of heart disease and stroke. Medicines are optional, but you may consider them.

If you have diabetes

Keep LDL at less than 100.

Your doctor may want your goal to be less than 70, based on your risk factors.

People who have diabetes have a higher risk of heart attack or stroke than people who don't have diabetes. Heart disease is a leading cause of death in people with diabetes. Also, in people with diabetes:

  • Heart attacks occur earlier.
  • Heart attacks are more likely to cause death.

Getting your cholesterol to this level means:

  • Making changes in what you eat.
  • Getting more exercise.
  • Taking medicine.

References

Citations

  1. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.
  2. Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Specialist Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Last Revised November 15, 2013

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