The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of having a heart attack or other diseases caused by hardening of the arteries. In general, the higher your LDL level and the more risk factors you have, the greater your chances of developing heart disease or having a heart attack. (A risk factor is a condition that increases your chance of getting a disease.) Some people are at high risk for heart attack because they already have heart disease. Other people are at high risk for developing heart disease because they have diabetes or a combination of risk factors for heart disease. Follow the steps below to find out your risk for getting heart disease.
Check the list to see how many of the risk factors you have. These are the risk factors that affect your LDL goal:
* Cigarette smoking
* High blood pressure (140/90 or higher or on blood pressure medicine)
* Low HDL cholesterol (less than 40 mg/dL)*
* Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
* Age (men 45 years or older; women 55 years or older).
* If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count
If you have 2 or more of the risk factors in the list above, use the NHLBI 10-Year Risk Calculator to find your risk score. Risk score refers to the chance of having a heart attack in the next 10 years, given as a percentage. Use your medical history, number of risk factors, and risk score to find your risk of developing heart disease or having a heart attack in the table below.
If you have
You Are in Category
And Your LDL Goal is
Heart disease, diabetes or risk score more than 20%
I. Highest Risk
Less than 100 mg/dL
2 or more risk factors and risk score 10 to 20%
II. Next Highest Risk
Less than 130 mg/dL
2 or more risk factors and risk score less than 10%
III. Moderate Risk
Less than 130 mg/dL
0 or 1 risk factor
IV. Low to Moderate Risk
Less than 160 mg/dL
After following the above steps, you should have an idea about your risk for getting heart disease or having a heart attack. The higher your risk, the lower your LDL goal. There are 2 main ways to lower your cholesterol:
Therapeutic Lifestyle Changes (TLC) --includes a cholesterol-lowering diet (called the TLC Diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.
Drug Treatment--if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.
The higher your risk for heart disease, the lower your LDL goal will be. Your doctor will set your LDL goal. Using the following guide, you and your doctor can develop a possible plan for treating your high blood cholesterol.
Category I, Highest Risk, your LDL goal is less than 100 mg/dL.
Your LDL Level
Treatment
If your LDL is 100 or above
You will need to begin the TLC diet together with drug treatment.
Even if your LDL is below 100
You should follow the TLC diet on your own to keep your LDL as low as possible.
Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL
Your LDL Level
Treatment
If your LDL is 130 or above
You will need to begin the TLC diet
If your LDL is 130 or more after 3 months on the TLC diet
You may need drug treatment along with the TLC diet.
If your LDL is less than 130
You will need to follow the heart healthy diet.
Category III, Moderate risk, your LDL goal is less than 130 mg/dL.
Your LDL Level
Treatment
If your LDL is 130 or above
You will need to begin treatment with the TLC diet
If your LDL is 160 or more after you have tried the TLC diet for 3 months
You may need drug treatment along with the TLC diet.
If your LDL is less than 130
You will need to follow the heart healthy diet.
Category IV, Low to Moderate Risk, your LDL goal is less than 160 mg/dL
Your LDL Level
Treatment
If your LDL is 160 or above
You will need to begin the TLC diet
If your LDL is still 160 or more after 3 months on the TLC diet
You may need drug treatment along with the TLC diet.
If your LDL is less than 160 mg/dL
You will need to follow the heart healthy diet.
Lowering Cholesterol with TLC
TLC is a set of lifestyle changes you can make to help lower your LDL cholesterol. The main parts of TLC are:
* The TLC Diet The TLC Diet recommends:
o Limiting the amount of saturated fat and cholesterol you eat.
o Eating only enough calories to achieve or maintain a healthy weight.
o Increasing the soluble fiber in your diet. For example, oatmeal, kidney beans, and apples are good sources of soluble fiber.
o Adding cholesterol-lowering food such as margarines that contain plant sterol or stanol esters for some people.
* Weight Management
Losing weight if you are overweight can help lower LDL. Weight management is especially important for those with a group of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
* Physical Activity
Regular physical activity is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.
Check the list to see how many of the risk factors you have. These are the risk factors that affect your LDL goal:
* Cigarette smoking
* High blood pressure (140/90 or higher or on blood pressure medicine)
* Low HDL cholesterol (less than 40 mg/dL)*
* Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
* Age (men 45 years or older; women 55 years or older).
* If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count
If you have 2 or more of the risk factors in the list above, use the NHLBI 10-Year Risk Calculator to find your risk score. Risk score refers to the chance of having a heart attack in the next 10 years, given as a percentage. Use your medical history, number of risk factors, and risk score to find your risk of developing heart disease or having a heart attack in the table below.
If you have
You Are in Category
And Your LDL Goal is
Heart disease, diabetes or risk score more than 20%
I. Highest Risk
Less than 100 mg/dL
2 or more risk factors and risk score 10 to 20%
II. Next Highest Risk
Less than 130 mg/dL
2 or more risk factors and risk score less than 10%
III. Moderate Risk
Less than 130 mg/dL
0 or 1 risk factor
IV. Low to Moderate Risk
Less than 160 mg/dL
After following the above steps, you should have an idea about your risk for getting heart disease or having a heart attack. The higher your risk, the lower your LDL goal. There are 2 main ways to lower your cholesterol:
Therapeutic Lifestyle Changes (TLC) --includes a cholesterol-lowering diet (called the TLC Diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.
Drug Treatment--if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.
The higher your risk for heart disease, the lower your LDL goal will be. Your doctor will set your LDL goal. Using the following guide, you and your doctor can develop a possible plan for treating your high blood cholesterol.
Category I, Highest Risk, your LDL goal is less than 100 mg/dL.
Your LDL Level
Treatment
If your LDL is 100 or above
You will need to begin the TLC diet together with drug treatment.
Even if your LDL is below 100
You should follow the TLC diet on your own to keep your LDL as low as possible.
Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL
Your LDL Level
Treatment
If your LDL is 130 or above
You will need to begin the TLC diet
If your LDL is 130 or more after 3 months on the TLC diet
You may need drug treatment along with the TLC diet.
If your LDL is less than 130
You will need to follow the heart healthy diet.
Category III, Moderate risk, your LDL goal is less than 130 mg/dL.
Your LDL Level
Treatment
If your LDL is 130 or above
You will need to begin treatment with the TLC diet
If your LDL is 160 or more after you have tried the TLC diet for 3 months
You may need drug treatment along with the TLC diet.
If your LDL is less than 130
You will need to follow the heart healthy diet.
Category IV, Low to Moderate Risk, your LDL goal is less than 160 mg/dL
Your LDL Level
Treatment
If your LDL is 160 or above
You will need to begin the TLC diet
If your LDL is still 160 or more after 3 months on the TLC diet
You may need drug treatment along with the TLC diet.
If your LDL is less than 160 mg/dL
You will need to follow the heart healthy diet.
Lowering Cholesterol with TLC
TLC is a set of lifestyle changes you can make to help lower your LDL cholesterol. The main parts of TLC are:
* The TLC Diet The TLC Diet recommends:
o Limiting the amount of saturated fat and cholesterol you eat.
o Eating only enough calories to achieve or maintain a healthy weight.
o Increasing the soluble fiber in your diet. For example, oatmeal, kidney beans, and apples are good sources of soluble fiber.
o Adding cholesterol-lowering food such as margarines that contain plant sterol or stanol esters for some people.
* Weight Management
Losing weight if you are overweight can help lower LDL. Weight management is especially important for those with a group of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
* Physical Activity
Regular physical activity is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.
