How Is High Blood Cholesterol Treated?

The main goal of cholesterol-lowering treatment is to lower your low-density lipoprotein (LDL) level enough to reduce your risk for having a heart attack or 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. Talk with your doctor about lowering your risk.

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 mg/dL or higher), or if you are on blood pressure medicine
• Low high-density lipoprotein (HDL) cholesterol (less than 40 mg/dL)¹
• 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 you have two or more of the risk factors in the list above, use the NHLBI 10-Year Risk Calculator to find your risk score. Risk scores refer to the chance of having a heart attack in the next 10 years, given as a percentage.

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

*Some people in this category are at very high risk because they have just had a heart attack or because they have a combination of heart disease together with diabetes, risk factors that are severe, or metabolic syndrome. If you are at very high risk, your doctor may set your LDL goal even lower, to less than 70 mg/dL. Your doctor may also set the LDL goal at this lower level if you have heart disease alone.

After following the above steps, you should have an idea about your risk for getting heart disease or having a heart attack. There are two main ways to lower your cholesterol in order to lower your risk:

• 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.

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

Category I, high risk, your LDL goal is less than 100 mg/dL.*

* Your LDL goal may be set even lower, to less than 70 mg/dL, if you are at very high risk or if you have heart disease. If you have this lower goal and your LDL is 70 mg/dL or higher, you will need to begin the TLC Diet together with drug treatment.

Category II, moderately high risk, your LDL goal is less than 130 mg/dL.

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

Category IV, low to moderate risk, your LDL goal is less than 160 mg/dL.

Lowering Cholesterol With TLC

TLC is a set of lifestyle changes you can make to help lower your LDL cholesterol. The main parts of TLC are:

• The TLC Diet, which recommends:
  • Limiting the amount of saturated fat, trans fat, and cholesterol you eat.
  • Eating only enough calories to achieve or maintain a healthy weight.
  • Increasing the soluble fiber in your diet. For example, oatmeal, kidney beans, and apples are good sources of soluble fiber.
  • Adding cholesterol-lowering foods, such as margarines that contain plant sterol or stanol esters that can help lower cholesterol.
• Weight management:
  • Losing weight if you are overweight can help lower LDL. Weight management is especially important for those with a group of risk factors that includes raised triglyceride and/or reduced HDL levels and being overweight with a large waist measurement (40 inches or more for men and 35 inches or more for women). This is called metabolic syndrome and it raises your risk for getting heart disease.
• Physical activity:
  • Regular physical activity is recommended for everyone. It can help raise HDL levels and lower LDL levels, and is especially important for those with raised triglyceride and/or reduced HDL levels who are overweight with a large waist measurement. Aim for at least 30 minutes of moderate-intensity activity, such as brisk walking, on most, and preferably all, days of the week.

Cholesterol-Lowering Medicines

Along with suggesting that you change the way you eat and exercise regularly, your doctor may prescribe medicines to help lower your cholesterol. Even if you begin drug treatment, you will need to continue TLC. TLC lowers your risk not only by lowering LDL but also in other ways and helps keep down the dose of LDL-lowering medication you have to take. Drug treatment controls but does not "cure" high blood cholesterol. Therefore, you must continue taking your medicine to keep your cholesterol level in the recommended range.

The five major types of cholesterol-lowering medicines are:

• Statins
  • Very effective in lowering LDL (bad) cholesterol levels
  • Safe for most people
  • Rare side effects to watch for are muscle and liver problems
• Bile Acid Sequestrants (seh-KWES-trants)
  • Help lower LDL cholesterol levels
  • Sometimes prescribed with statins
  • Not usually prescribed as the only medicine to lower cholesterol
• Nicotinic (Nick-o-TIN-ick) Acid
  • Lowers LDL cholesterol and triglycerides, and raises HDL (good) cholesterol
  • Should only be used under a doctor's supervision
• Fibrates
  • Lower triglycerides
  • May increase HDL (good) cholesterol levels
  • When used with a statin, may increase the chance of muscle problems
• Ezetimibe
  • Lowers LDL cholesterol
  • Acts within the intestine to block cholesterol absorption

• Make sure your cholesterol level is controlled
• Check for other health problems

You may take medicines for other health problems. It is important that you take ALL medicines as your doctor prescribes. The combination of medicines may lower your risk for heart disease or heart attack.

When trying to lower your cholesterol or keep it low, it is important to remember to follow your treatments for other conditions you may have, such as high blood pressure. Get help with quitting smoking and losing weight if they are risk factors for you.

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