High cholesterol treatment guidelines based on risk categories
The Canadian Cardiovascular Society (CCS) and the Canadian Working Group on Hypercholesterolemia and Other Dyslipidemias (WGHOD) recommendations for treatment with medicine are based on your cholesterol levels and your risk of having a heart attack.1, 2
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.3
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, chronic kidney disease, 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 and WGHOD 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.
- Medicine may be used, especially if needed to lower triglyceride levels or raise HDL levels.
- Begin the Therapeutic Lifestyle Changes (TLC) diet to help maintain a healthy LDL cholesterol level.
2.0 mmol/L or above
- Begin the Therapeutic Lifestyle Changes (TLC) diet.
- Strongly consider using medicine.
- Medicine is used for people in the high-risk category to try and 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 3.5 mmol/L (130 mg/dL) and to reduce both the short-term and long-term risk of heart attack.
For this group, the CCS and WGHOD recommends the following:
If your LDL level is:
Recommendation:
Less than 3.5 mmol/L (130 mg/dL)
No treatment is necessary. However, experts recommend the Therapeutic Lifestyle Changes (TLC) diet to help maintain a healthy LDL cholesterol level.
3.5 mmol/L (130 mg/dL) or above
Begin the Therapeutic Lifestyle Changes (TLC) diet and consider using medicine.
Medicine is sometimes used for people in this risk category to try and lower their LDL levels by 40% 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 bring your LDL cholesterol levels down to less than 5.0 mmol/L (195 mg/dL) and to reduce the long-term risk of heart attack. You are not at high short-term risk.
For this group, the CCS and WGHOD recommend the following:
If your LDL level is:
Recommendation:
Less than 5.0 mmol/L (195 mg/dL)
No treatment is necessary. However, experts recommend the Therapeutic Lifestyle Changes (TLC) diet to help maintain a healthy LDL cholesterol level.
5.0 mmol/L (195 mg/dL) or above
Begin the Therapeutic Lifestyle Changes (TLC) diet and consider using medicines.
Medicine is sometimes used for people in this risk category to try and lower their LDL levels by 40% or more.
| Author: | Douglas Dana Ralph Poore | Last Updated: November 13, 2006 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Tom Bailey, MD - Family Medicine Neil J. Stone, MD, FACC, FACP - Internal Medicine, Cardiology | |
 | ||
| |