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Cholesterol Treatment Guidelines

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 American College of Cardiology and the American Heart Association.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 clearly recommended for these people

Some people may need to start taking medicine right away. That's because their chance of having heart attack and stroke is high, and statins can reduce this risk.

Your doctor is likely to recommend statins if you:

Statins recommended for these people

Some people may need to start taking medicine right away because their risk of having a heart attack and stroke is high enough that the benefits outweigh the risks.

Your doctor is likely to recommend statins if:

  • Your LDL cholesterol is190 mg/dL or above.
  • You have diabetes and you are age 40 to 75.
  • Your 10-year risk of heart attack or stroke is 7.5% or above and you are age 40 to 75.
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:

  • Your family history of early heart disease. Early heart disease means you have a male family member who was diagnosed before age 55 or a female family member who was diagnosed before age 65
  • A high LDL cholesterol test result (160 mg/dL or higher)
  • 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 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, cholesterol absorption inhibitors, fibric acid derivatives, and nicotinic acid (niacin).

References

Citations

  1. Stone NJ, et al. (2013). 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online November 12, 2013. DOI: 10.1161/01.cir.0000437738.63853.7a. Accessed November 18, 2013.

Other Works Consulted

  • Fleg JL, et al. (2013). Secondary prevention of atherosclerotic cardiovascular disease in older adults: A scientific statement from the American Heart Association. Circulation, published online October 28, 2013. DOI: 10.1161/01.cir.0000436752.99896.22. Accessed November 22, 2013.
  • Goff DC Jr, et al. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online November 12, 2013. DOI: 10.1161/01.cir.0000437741.48606.98. Accessed November 22, 2013.

Credits

By Healthwise Staff
Kathleen Romito, MD - Family Medicine
Robert A. Kloner, MD, PhD - Cardiology
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Last Revised December 4, 2013

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