Lifestyle changes (such as diet, weight control, exercise, and smoking cessation) are the first line of defense for treating unhealthy cholesterol levels. If levels still remain high, drug treatment is an effective next step. However, while statins have been shown to slow the rate of atherosclerotic progression, they have not yet been shown to reverse heart disease.
Reducing LDL (“bad” cholesterol) and total cholesterol levels, while at the same time boosting HDL (“good” cholesterol) levels, can prevent heart attacks and death in all people (with or without heart disease). Reducing LDL is the primary goal of most cholesterol therapy. Cholesterol-lowering medications are used along with healthy lifestyle habits, not in place of them. Lowering cholesterol levels with lifestyle changes and drug treatment has been shown to decrease the risk of heart attacks and other complications of atherosclerosis.
The National Cholesterol Education Program’s (NCEP) clinical practice guidelines set treatment goals for LDL levels based on a patient's risk factors for heart disease. The risk factors include:
- Having a first-degree female relative diagnosed with heart disease before age 65 or a first-degree male relative diagnosed before age 55
- Being male and over age 45 or female and over age 55
- Cigarette smoking
- High blood pressure
- Metabolic syndrome (risk factors associated with obesity such as low HDL levels and high triglycerides)
Two or more of these risk factors increases by 20% the chance of having a heart attack within 10 years.
The LDL cholesterol level is one of the most important factors in determining whether a patient needs cholesterol therapy and whether the treatment is working properly. In particular, guidelines emphasize lower LDL levels and earlier treatment for people with coronary artery disease, or other forms of atherosclerosis, and diabetes. (For a table of Cholesterol Goals for Adults, see Introduction section of this report.)
Review Date: 04/06/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.