How Is High Blood Cholesterol Treated?

The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of having a heart attack or other diseases caused by hardening of the arteries. In general, the higher your LDL level and the more risk factors you have, the greater your chances of developing heart disease or having a heart attack. (A risk factor is a condition that increases your chance of getting a disease.) Some people are at high risk for heart attack because they already have heart disease. Other people are at high risk for developing heart disease because they have diabetes or a combination of risk factors for heart disease. Follow the steps below to find out your risk for getting heart disease.

Check the list to see how many of the risk factors you have. These are the risk factors that affect your LDL goal:

Cigarette smoking
High blood pressure (140/90 or higher or on blood pressure medicine)
Low HDL cholesterol (less than 40 mg/dL)*
Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
Age (men 45 years or older; women 55 years or older).

* If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count

Use your medical history, number of risk factors, and risk score to find your risk of developing heart disease or having a heart attack in the table below.

If you have	You Are in Category	And Your LDL Goal is
Heart disease, diabetes or risk score more than 20%	I. Highest Risk	Less than 100 mg/dL
2 or more risk factors and risk score 10 to 20%	II. Next Highest Risk	Less than 130 mg/dL
2 or more risk factors and risk score less than 10%	III. Moderate Risk	Less than 130 mg/dL
0 or 1 risk factor	IV. Low to Moderate Risk	Less than 160 mg/dL

After following the above steps, you should have an idea about your risk for getting heart disease or having a heart attack. The higher your risk, the lower your LDL goal. There are 2 main ways to lower your cholesterol:

Therapeutic Lifestyle Changes (TLC) –includes a cholesterol-lowering diet (called the TLC Diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.

Drug Treatment–if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

The higher your risk for heart disease, the lower your LDL goal will be. Your doctor will set your LDL goal. Using the following guide, you and your doctor can develop a possible plan for treating your high blood cholesterol.

Category I, Highest Risk, your LDL goal is less than 100 mg/dL.

Your LDL Level	Treatment
If your LDL is 100 or above	You will need to begin the TLC diet together with drug treatment.
Even if your LDL is below 100	You should follow the TLC diet on your own to keep your LDL as low as possible.

Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL

Your LDL Level	Treatment
If your LDL is 130 or above	You will need to begin the TLC diet
If your LDL is 130 or more after 3 months on the TLC diet	You may need drug treatment along with the TLC diet.
If your LDL is less than 130	You will need to follow the heart healthy diet.

Category III, Moderate risk, your LDL goal is less than 130 mg/dL.

Your LDL Level	Treatment
If your LDL is 130 or above	You will need to begin treatment with the TLC diet
If your LDL is 160 or more after you have tried the TLC diet for 3 months	You may need drug treatment along with the TLC diet.
If your LDL is less than 130	You will need to follow the heart healthy diet.

Category IV, Low to Moderate Risk, your LDL goal is less than 160 mg/dL

Your LDL Level	Treatment
If your LDL is 160 or above	You will need to begin the TLC diet
If your LDL is still 160 or more after 3 months on the TLC diet	You may need drug treatment along with the TLC diet.
If your LDL is less than 160 mg/dL	You will need to follow the heart healthy diet.