What Are "Desirable" Cholesterol Levels?
Total cholesterol: Desirable blood levels for total cholesterol are below 200 mg/dL. Levels between 200 and 239 are considered "borderline." Levels above 240 are considered high.LDL cholesterol: Optimal LDL levels are less than 100 mg/dL. Near optimal levels are between 100 and 129. Levels between 130 and 159 are considered "borderline;" levels between 160 and 189 are considered "high;" and levels of 190 and above are considered "very high."
HDL cholesterol: In general, the higher the HDL cholesterol levels the better. HDL levels below 41 mg/dL are considered too low.
Who Needs To Be Treated For Elevated Cholesterol?
While various professional groups have offered guidelines for treating cholesterol, most American physicians follow the current recommendations from the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, or ATP III). The ATP III guidelines recommend making treatment decisions according to two considerations:- the LDL cholesterol levels
- the presence of these additional risk factors
Additional risk factors that modify cholesterol goals:
- cigarette smoking
- diabetes
- hypertension -- blood pressure greater than 140/90
- blood pressure medication
- low HDL cholesterol
- family history of premature heart disease (close male relative with heart disease before age 55, or close female relative with heart disease before age 65)
- age greater than 45 in men, or greater than 55 in women
- an estimated 10-year risk of heart attack of 20% or higher, calculated using a formula derived from the Framingham study. NIH Online Version of the 10-year Risk Calculator
Based on these two items (i.e., lipid levels and presence of additional risk factors) treatment is recommended as follows:
For those with 0 - 1 risk factors:The target LDL level is 160 mg/dL or lower. If the LDL level is greater than 159, lifestyle changes should be initiated to reduce cholesterol levels. If the LDL level is greater than 189, drug treatment should be strongly considered.
For those with 2 or more risk factors:The target LDL level is 130 mg/dL or lower. If the LDL level is greater than 129, lifestyle changes should be initiated. Drug therapy should be strongly considered for LDL levels above 159.
If heart disease is already present, or the calculated 10-year risk of heart attack is greater than 20%, or if diabetes is present: The target LDL level is 100 mg/dL or lower. If the LDL level is greater than 100, lifestyle changes should be initiated. If the LDL level is greater than 129, drug treatment should be strongly considered.
What About Treatment for High Triglycerides?
The latest guidelines recommend treating patients who have elevated triglyceride levels. The decision to treat is generally based on the triglyceride levels themselves. Normal triglyceride levels are less than 150 mg/dL. Borderline high levels are 150-199 mg/dl. High levels are 200-499 mg/dL, and very high triglyceride levels are greater than 500 mg/dL.Most people with elevated triglyceride levels have metabolic syndrome (or diabetes), so the foundation of therapy is lifestyle modification, specifically, weight loss and exercise. Drug therapy is often required, however, if triglyceride levels are in the "very high" range.
What Other "Special Circumstances" Deserve Attention?
Patients with very high LDL cholesterol levels (greater than 189 mg/dL): These patients often have a genetic form of lipid disorder. Not only do they have a high risk of premature heart disease without aggressive therapy, but their family members should ALSO be screened for elevated cholesterol levels; those with high cholesterol levels also need to be treated.Patients with low HDL cholesterol levels (less than 40 mg/dL): The latest guidelines recognize low HDL levels as a strong independent risk factor for coronary artery disease. Many of patients with low HDL will have diabetes or metabolic syndrome. They are often overweight and physically inactive. Other causes of low HDL levels are smoking, very high carbohydrate diets (greater than 60% of calories accounted for by carbohydrates), and drugs (such as steroids and progesterone). Treatment low HDL levels is usually aimed at weight reduction, smoking cessation, exercise, and controlling other risk factors (such as hypertension, LDL cholesterol, and triglycerides). Therapy with niacin may also increase HDL levels.
