Cholesterol Guidelines for People with High Risk of Heart Attack

Image for cholesterol article The National Cholesterol Education Program (NCEP) offers cholesterol guidelines for men and women.

Cholesterol and Heart Disease

High 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 Guidelines

The 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)
NCEP's recommendations include:
Risk Category Drug Therapy Based on LDL levels
High risk
  • If equal to or above 100 mg/dL (2.6 mmol/L)
  • Optional between 70-100 mg/dL (1.8-2.6 mmol/L) if very high risk
Moderately high risk
  • If above 130 mg/dL (3.4 mmol/L)
  • Optional between 100-129 mg/dL (2.6-3.3 mmol/L)
Moderate risk
  • If equal to or above 160 mg/dL (4.2 mmol/L)
Lower risk
  • If equal to or above 190 mg/dL (4.9 mmol/L) after lifestyle changes
  • Optional if 160-189 mg/dL (4.2-4.9 mmol/L) after lifestyle changes
The guidelines also state that drug treatment for high-risk patients must be aggressive enough to achieve at least a 30%-40% reduction in LDL levels. In addition to drug therapy, NCEP stresses the importance of initiating therapeutic lifestyle changes in high-risk persons—regardless of cholesterol level—since lifestyle changes can reduce cardiovascular risk in several ways besides lowering cholesterol.

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