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.
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.
|
