Topic Overview

The goal in treating cholesterol is to lower your chance of having a heart attack or a stroke. The goal is not to lower your cholesterol numbers alone.

The following guidelines are from the Canadian Cardiovascular Society (CCS).^{footnote 1}

The two types of treatment are:

1. Lifestyle changes.
2. Medicines called statins.

The way you choose to lower your risk will depend on how high your risk for heart attack and stroke is. It will also depend on how you feel about taking medicines. Your doctor can help you know your risk. Your doctor can help you balance the benefits and risks of your treatment options.

Lifestyle changes

Lifestyle changes are always important, even if you take medicines to lower your risk.

Your doctor may suggest that you make one or more of the following changes:

• Eat heart-healthy foods.
• Lose weight if you need to, and stay at a healthy weight.
• Be active on most, if not all, days of the week.
• Don't smoke.

Statins

You and your doctor can work together to understand your risks and what treatment is best for you. Your doctor may recommend that you take statins if the benefits outweigh the risks.

Statins strongly recommended for these people

Your doctor is likely to strongly recommend statins if you:

• Have heart disease.
• Have peripheral arterial disease.
• Had a heart attack.
• Had a stroke or transient ischemic attack (TIA).
• Have or had an abdominal aortic aneurysm.
• Have chronic kidney disease.

Statins recommended for these people

Your doctor is likely to recommend statins if:

• Your LDL cholesterol is 5.0 mmol/L or above.
• You have diabetes and any of the following is true:
  • You are age 40 or older.
  • You are age 30 or older and have had diabetes for more than 15 years.
  • Your diabetes has caused problems with your eyes, kidneys, or nerves.
• Your risk of a heart attack or stroke is 10% or greater and either your cholesterol is 3.5 mmol/L or above or you have certain other risk factors. .

Statins not as clearly recommended for these people

For some people, it's not as clear if they need to take a statin. You and your doctor will need to look at your overall health and any other risks you have for heart attack and stroke.

You and your doctor may think about these things in deciding about medicine:

• Having a risk for heart attack or stroke between 5 and 9% even though the LDL cholesterol test result is less than 5.0 mmol/L
• Results of tests such as C-reactive protein, coronary calcium scan, or ankle-brachial index
• Your lifetime risk of heart attack and stroke

Other medicines

Your doctor may also talk to you about cholesterol absorption inhibitors or PCSK9-inhibitors. These medicines can also reduce the risk of heart attack and stroke for some people.

Other medicines can improve cholesterol levels, but they have not been proven to lower the risk of a heart attack or a stroke. Your doctor may recommend these medicines if there is a reason you can't take a statin. These medicines include bile acid sequestrants, fibric acid derivatives, and nicotinic acid (niacin).