An in-depth report on the diagnosis, treatment, and prevention of unhealthy cholesterol levels.
Hypercholesterolemia; LDL; HDL; Triglycerides
A blood test is used to measure cholesterol levels. A person's total cholesterol level includes measurements of LDL (bad cholesterol), HDL (good cholesterol), and triglycerides.
New Cholesterol Guidelines
Over the past 2 to 3 years, a different approach to treating abnormal cholesterol levels has been developed. Previous guidelines recommended that doctors use specific target goals for LDL depending on patient risk factors. The newer guidelines take a different approach:
- The treatment emphasis now focuses on reducing the risk for diseases caused by atherosclerosis, including abnormal cholesterol, but not targeting subsequent cholesterol lab results precisely.
- Several risk calculators are available which consider a person's gender, age, race, total cholesterol, HDL, blood pressure, diabetes, and smoking to estimate their risk for having a heart attack or stroke within the next 10 years. Based on these results, your doctor may recommend treatment with a cholesterol-lowering statin drug.
- Heart-healthy lifestyle changes (diet, exercise, smoking cessation, and weight control) still remain the foundation for cholesterol treatment. Lifestyle management is used before, and during, drug therapy.
Guidelines recommend drug therapy based on a person's risk for heart disease, stroke, and other problems caused by hardening of the arteries:
- Primary prevention refers to risk reduction in those who do not yet have evidence of cardiovascular disease.
- Secondary prevention refers to risk reduction in those who have evidence of cardiovascular disease.
- Statins are the first choice in virtually all patients with abnormal cholesterol levels to prevent cardiovascular disease.
- When to start statins and what dose to use is based on a patient's risk for cardiovascular disease.
- Total cholesterol and LDL cholesterol blood levels rarely need to be monitored once statins have been prescribed.
- Newer, biologic drugs have been approved for reducing the LDL cholesterol level in certain high risk scenarios.
The key lifestyle changes to improve unhealthy cholesterol levels are:
- Heart-healthy diet (with emphasis on vegetables, fruits, and whole grains)
- Regular physical activity (The AHA recommends performing 30 minutes of moderate exercise for a total of 150 minutes a week or 75 minutes a week total of vigorous exercise)
- Healthy body weight (with a doctor's help when necessary)
- Don't smoke
- Control of high blood pressure and diabetes (for patients who also have these conditions)