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.
If You Have |
You Are in Category |
And Your LDL Goal Is |
Heart disease, diabetes, or a risk score higher than
20% |
I. High risk |
Less than 100 mg/dL* |
Two or more risk factors and a risk score
1020% |
II. Moderately high risk |
Less than 130 mg/dL |
Two or more risk factors and a risk score lower
than 10% |
III. Moderate risk |
Less than 130 mg/dL |
One or no risk factors |
IV. Low
to moderate risk |
Less
than 160 mg/dL |
*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 Treatmentif 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 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. |
* 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.
Your LDL Level |
Treatment |
If your LDL is 130 mg/dL or above |
You will need to begin the
TLC
Diet. |
If your LDL is 130 mg/dL 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 mg/dL |
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 mg/dL or above |
You will need to begin treatment with the
TLC
Diet. |
If your LDL is 160 mg/dL 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 mg/dL |
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 mg/dL or above |
You will need to begin the
TLC
Diet. |
If your LDL is still 160 mg/dL 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. |
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
When you are under treatment, you will be checked
regularly to:
- 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.
____________ 1If
your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total
count. |