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High Cholesterol Treatment Guidelines Based on Heart Attack Risk

Topic Overview

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 Canadian Cardiovascular Society (CCS) recommendations for treatment with medicine are based on your cholesterol levels and your risk of having a heart attack.1

Knowing your risk is important to determine whether you should start taking medicine right away or whether you can first try lifestyle changes to lower your cholesterol.2

Your doctor will help you figure out your risk of heart disease and your risk of a heart attack or stroke. But you can check your own risk for a heart attack by using the Interactive Tool: Are You at Risk for a 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.

High risk (a 20% or greater chance of having a heart attack in 10 years)

People who are at high risk have more than a 20% chance of having a heart attack in 10 years. They have coronary artery disease (CAD), have had a heart attack, have stable or unstable angina, or have had angioplasty or bypass surgery. This category also includes people who have diseases or conditions that are considered equally as serious as CAD. These are peripheral arterial disease, abdominal aortic aneurysm, transient ischemic stroke or ischemic stroke, and diabetes.

Treatment guidelines

The goal of the treatment choices for this high-risk category is to bring your LDL cholesterol levels down to less than 2.0 mmol/L (80 mg/dL) and reduce the short-term risk of heart attack.

For this group, the CCS recommends the following:

 If your LDL level is: Recommendation:

Less than 2.0 mmol/L (80 mg/dL)

  • This is the target LDL level for people in the high risk category.
  • Begin or continue making healthy lifestyle choices to help maintain a healthy LDL cholesterol level. The Therapeutic Lifestyle Changes (TLC) program is a good place to start.
  • Medicine may be used, especially if needed to lower triglyceride levels or raise HDL levels.

2.0 mmol/L or above

  • Begin or continue making healthy lifestyle choices. The Therapeutic Lifestyle Changes (TLC) program can help you reach a healthy LDL cholesterol level.
  • Strongly consider using medicine.
  • Medicine is used for people in the high-risk category to try to lower their LDL levels by 50% or more.

Intermediate risk (10% to 19% risk of having a heart attack in 10 years)

People who are at intermediate risk have a 10% to 19% risk of having a heart attack in 10 years.

Treatment guidelines

The goal of the treatment choices in this intermediate-risk category is to bring your LDL cholesterol levels down to less than 2.0 mmol/L (80 mg/dL) and to reduce both the short-term and long-term risk of heart attack.

For this group, the CCS recommends the following:

 If your LDL level is: Recommendation:

Less than 3.5 mmol/L (130 mg/dL)

No treatment is necessary. But experts recommend healthy lifestyle choices to help maintain a healthy LDL cholesterol level. The Therapeutic Lifestyle Changes (TLC) program is a good place to start.

3.5 mmol/L or above

Begin or continue making healthy lifestyle choices. The Therapeutic Lifestyle Changes (TLC) program can help you reach a healthy LDL cholesterol level.

Medicine may be used for people in this risk category to try to lower their LDL levels by 50% or more.

Low risk (less than a 10% risk of having a heart attack in 10 years)

People who are at low risk have less than a 10% risk of having a heart attack in 10 years.

Treatment guidelines

The goal of the treatment choices in this low-risk category is to lower your LDL cholesterol levels by 50% or more and to reduce the long-term risk of heart attack. You are not at high short-term risk.

For this group, the CCS recommends the following:

 If your LDL level is: Recommendation:

Less than 5.0 mmol/L (195 mg/dL)

No treatment is necessary. But experts recommend healthy lifestyle choices to help maintain a healthy LDL cholesterol level. The Therapeutic Lifestyle Changes (TLC) program is a good place to start.

5.0 mmol/L or above

Begin or continue making healthy lifestyle choices. The Therapeutic Lifestyle Changes (TLC) program can help you reach a healthy LDL cholesterol level.

Medicine is sometimes used for people in this risk category to try to lower their LDL levels by 50% or more.

References

Citations

  1. Genest J, et al. (2009). Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult—2009 recommendations. Canadian Journal of Cardiology, 25(10): 567–579.
  2. 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.

Credits

By Healthwise Staff
Kathleen Romito, MD - Family Medicine
Donald Sproule, MDCM, CCFP - Family Medicine
Robert A. Kloner, MD, PhD - Cardiology
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Last Revised September 20, 2012
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