New Cholesterol Level Guidelines

High-risk patients advised to aggressively lower LDL (bad) cholesterol
Based on a review of recent clinical trials, a National Cholesterol Education Program (NCEP) update recommends more intensive treatment for people at moderately high to very high risk for heart attack. Research suggests that the more you lower LDL, the less likely you are to have a heart attack. The new guidelines recommend cholesterol-lowering medications (statins alone or with other medications) for most people at high risk for heart attack and whose LDL levels are over 100 mg/dL. Details include:

Very high risk for heart attack
Includes those who have just had a heart attack, who already have heart disease and diabetes, are regular smokers and have high blood pressure, or have other multiple risk factors.

  • New recommendation: Overall goal is to keep LDL level at less than 100 mg/dL, but there is an option for using medications or a combination of medications to lower LDL to less than 70 mg/dL.
  • Previous recommendation: Goal was for those at “high risk” only, and was to lower LDL to less than 100 mg/dL. “Very high risk” is considered a subset of the high-risk category.



High risk for heart attack:
Includes those with heart disease, diabetes, metabolic syndrome, or multiple risk factors.

  • New recommendation: Use medications for those with an LDL of 100 to 129 mg/dL. LDL goal is less than 100 mg/dL.
  • Previous recommendation: Threshold for starting medications was 130 mg/dL, but was "optional" for those with LDL of 100 to 129 mg/dL.



Moderately high risk for heart attack:
Includes those with multiple risk factors.

  • New recommendation: Goal is less than 100mg/dL. Recommendation to use medication to reach that goal if LDL is 100 to 129 mg/dL.
  • Previous recommendation: Goal was less than 130 mg/dL with medication recommended if LDL was 130 mg/dL or higher.

In addition, the new guidelines recommend that when people at high and moderately high risk of heart attack take medications, the therapy should be intense enough to reduce LDL levels by 30% to 40%.

Those at moderately high or high risk for heart attack should begin therapeutic lifestyle changes (low saturated-fat diet and exercise) regardless of LDL level.


Credits:
Writer: Ellie Rodgers
Editor: Geri Metzger
Associate Editor: Terrina Vail
Medical Reviewer: Adam Husney, M.D
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