Treatment
In 2004, the National Cholesterol Education Program issued its latest recommendations for cholesterol control and management. These guidelines increase the number of Americans who should be taking LDL-lowering medication.
Starting Medications. Even modest lowering of high cholesterol levels, whether through drug therapy or lifestyle changes, reduces the risk of disability and death from heart disease. Most experts now focus on lowering LDL cholesterol, the "bad" kind. Reducing LDL levels is particularly critical for patients with diabetes.
The doctor will start or consider medication when:
- LDL cholesterol is 190 mg/dL or higher.
- LDL cholesterol is 160 mg/dL or higher AND patient has one risk factor for heart disease.
- LDL cholesterol is 130 mg/dL or higher AND patient has either diabetes or two other risk factors for heart disease.
- LDL cholesterol is 100 mg/dL or higher AND patient has heart disease. (If patient has diabetes, even without heart disease, medication may be considered for an LDL cholesterol of 100 mg/dL)
- LDL cholesterol is greater than 70 mg/dL AND patient has had a recent heart attack or has known heart disease along with diabetes, current cigarette smoking, poorly controlled high blood pressure, or the metabolic syndrome (high triglycerides, low HDL, and obesity).
Risk factors for heart disease 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
- Diabetes
- High blood pressure
- Metabolic syndrome (risk factors associated with obesity such as low HDL levels and high triglycerides)
Recent studies have found that aggressive lipid lowering with high-dose statin therapy is more beneficial than standard statin therapy in patients with existing heart disease. The Pravastatin or Atorvastatin Evaluation and Infection Trial (PROVE-IT) and the Reversal of Atherosclerosis with Aggressive Lipid-Lowering trial (REVERSAL) compared the benefits of standard statin therapy (pravastatin, 40 mg) with intensive statin therapy (atorvastatin, 80 mg) in treating patients with heart disease.
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