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.^{footnote 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.^{footnote 2}

Your doctor will help you figure out your risk of heart disease and your risk of a heart attack or stroke.

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:

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:

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: