Cholesterol Guidelines for People with High Risk of Heart Attack
The National Cholesterol Education Program (NCEP) offers cholesterol guidelines for men and women.
Cholesterol and Heart DiseaseHigh levels of LDL cholesterol and/or low levels of high-density lipoprotein (HDL, or “good”) cholesterol, are major risk factors for heart attack and stroke, two of the most common causes of death in the US. The good news is that most people can control major heart disease risk factors, including cholesterol levels, smoking, excessive weight, lack of exercise, high blood pressure , and type 2 diabetes . Screening for lipid disorders like high cholesterol depends on your age and whether you have any risk factors for heart disease.
A Run-Down of the GuidelinesThe guidelines propose different recommendations depending on a person’s degree of risk of heart attack within the next ten years. This risk is determined by the presence of several risk factors, including history of heart attack or stroke, unstable or stable angina (chest pain), history of coronary artery procedures, evidence of clogged arteries (myocardial ischemia), diabetes, metabolic syndrome, high LDL cholesterol, low HDL cholesterol, high blood pressure, smoking, family history of heart disease, and age. There are three major risk levels:
- High risk (over 20% chance of heart attack within ten years) including those with coronary heart disease (CHD) or those having a CHD risk equivalent—diabetes, peripheral arterial disease, abdominal aortic aneurysm, or carotid artery disease)
- Moderately high risk (10%-20% chance of heart attack within ten years)
- Moderate risk (less than 10% chance of heart attack within ten years, but still with two or more risk factors)
- Lower risk (a person with one or fewer risk factors)
|Risk Category||Drug Therapy Based on LDL levels|
|High risk|| |
|Moderately high risk|| |
|Moderate risk|| |
|Lower risk|| |
Lifestyle TherapyNCEP recommends the following lifestyle changes:
- Eat a diet low in saturated fat and cholesterol
- Eat plenty of plant based foods to get the beneficial sterols and stanols that they contain.
- Increase soluble fiber in your diet (eg, whole grains, vegetables, fruits, nuts, and seeds)
- Maintaining a healthy weight
- Getting regular physical activity
Drug TherapyStatins are often prescribed for high cholesterol. They are designed to be used in combination with lifestyle therapy. Statins works by blocking an enzyme (HMG-CoA reductase) that helps the body make cholesterol. The benefit from these medicines may also come from their anti-inflammation properties. Common examples of statins include:
American Heart Association
National Heart, Lung and Blood Institute
Heart and Stroke Foundation of Canada
American College of Cardiology/American Heart Association. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. J Am Coll Cardiol . 2013: early online. Available at: http://content.onlinejacc.org/article.aspx?articleID=1770217. Accessed January 6, 2013.
Cardiovascular disease prevention overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated September 9, 2012. Accessed September 19, 2012.
NCEP ATP III guidelines. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Accessed September 19, 2012.
Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. National Heart, Lung, and Blood Institute. Available at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf. Accessed September 19, 2012.
Screening for lipid disorders in adults: U.S. Preventive Services Task Force recommendation statement. National Guidelines Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?doc%5Fid=12634#s23 . Published June 2008. Accessed September 19, 2012.
Statins. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated September 3, 2012. Accessed September 19, 2012.
What your cholesterol levels mean. American Heart Association. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/What-Your-Cholesterol-Levels-Mean%5FUCM%5F305562%5FArticle.jsp. Updated August 23, 2012. Accessed September 19, 2012.
- Reviewer: Brian Randall, MD
- Review Date: 10/2012
- Update Date: 10/30/2012