High Cholesterol Treatment Guidelines Based on Risk Categories

Topic Overview

Knowing your risk of having a heart attack is important. It helps you and your doctor decide whether you should start taking medicine right away or whether you can first try lifestyle changes to lower your cholesterol.

Your doctor will use your health and family history to check your risk of a heart attack. You can find your risk by using the Interactive Tool: Are You at Risk for a Heart Attack? Use the percentage you get from the tool to find your risk category in the table below:

Your Risk Category
Risk category Risk of a heart attack within 10 years
Highest (category I) More than 20%
Moderately high (category II) 10% to 20%
Moderate (category III) Less than 10%
Lower (category IV) No coronary artery disease; 1 or 0 risk factors

Recommended treatments

Highest risk (Category I)

Keep LDL at 70 or below.

Getting your cholesterol to this level means:

  • Making changes in what you eat.
  • Getting more exercise.
  • Taking medicine, especially if you have coronary artery disease or other risk factors and need to get your LDL to less than 70.

You also may want to talk to your doctor about taking a low-dose aspirin each day. It may help reduce your risk of heart attack.

Even if you are taking medicines, a healthy lifestyle will help lower your risk of a heart attack. If you need to make healthy changes, a good place to start is the Therapeutic Lifestyle Changes, or TLC, program. The program will help you eat better, exercise more, and lose weight if you need to. When you start to make these changes part of your daily life, you will be on the way to reducing your risk of heart disease and stroke.

Moderately high or Moderate risk (Category II or III)

Keep LDL at less than 130.

Getting your cholesterol to this level means:

  • Making changes in what you eat.
  • Getting more exercise.

You may have to take medicine too.

Check out the Therapeutic Lifestyle Changes, or TLC, program. It can help you lower your cholesterol and your risk of heart disease and stroke.

Lower risk (Category IV)

Keep LDL at less than 160.

Starting on the Therapeutic Lifestyle Changes program can help you keep your cholesterol low, along with your risk of heart disease and stroke. Medicines are optional, but you may consider them.

If you have diabetes

Keep LDL at less than 100. Even better, keep it at 70.

People with diabetes have a higher risk of heart attack or stroke than people without diabetes. Heart disease is a leading cause of death in people with diabetes. Also, in people with diabetes:

  • Heart attacks occur earlier.
  • Heart attacks are more likely to cause death.

Getting your cholesterol to this level means:

  • Making changes in what you eat.
  • Getting more exercise.
  • Taking medicine.

Credits

Author Robin Parks, MS
Author Christopher Hess
Editor Kathleen M. Ariss, MS
Editor Cynthia Tank
Editor Katy E. Magee, MA
Associate Editor Pat Truman, MATC
Associate Editor Michele Cronen
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Sue Barton, PhD, PsyD - Behavioral Health
Specialist Medical Reviewer Robert A. Kloner, MD, PhD - Cardiology
Specialist Medical Reviewer Carl Orringer, MD - Cardiology, Clinical Lipidology
Last Updated July 11, 2008

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