Do You Need To Be Treated for High Cholesterol?

Who Needs To Be Treated For High Cholesterol Levels?

If you have elevated cholesterol levels, chances are that the decision you and your doctor will make regarding treatment will be based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), published in 2002 and updated in 2004.

These guidelines address two issues: first, whether you need to be treated, and second, if you do need to be treated, which treatment ought to be used. This article addresses whether you need to be treated. You can read here about deciding on the most appropriate treatment, if treatment is necessary.

According the ATP III guidelines, whether you need to be treated depends on two factors: your LDL cholesterol level, and your estimated risk of having a "cardiac event" (such as a heart attack) over the next 10 years.

• Read about LDL cholesterol and the other "kinds" of cholesterol.

• Read about measuring cholesterol levels.

The level of LDL cholesterol that is considered significant (in terms of requiring treatment) depends on the estimation of your 10-year risk of a cardiac event.

Estimating Your 10-Year Risk

Based on your medical history, physical exam, and lab results, you will be assigned to a high, intermediate, or low-risk category.

High Risk: You are considered to be at high risk if your 10-year risk of having a cardiac event is estimated to be 20% or higher. You are in this high-risk category if you already have coronary artery disease (CAD) that has produced angina, or a myocardial infarction (heart attack), or that has required treatment with stenting or bypass surgery.

You are also considered to be in the high-risk category if you have one or more of the following medical conditions:

• Peripheral artery disease
• Abdominal aortic aneurysm
• Diabetes mellitus
• Multiple risk factors sufficient to result in a 10-year risk of cardiac events of 20% or higher (see below)

Intermediate risk: You are in the intermediate-risk category if you have two or more of the following risk factors:

• Cigarette smoking
• Hypertension (blood pressure greater than 139/89 mmHg, or taking blood pressure medicine)
• Low HDL cholesterol (HDL level 39 mg/dL or lower)
• 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 54 if you are a man, or greater than 64 if you are a woman
• If your HDL cholesterol is 60 mg/dL or higher, take one risk factor away from the total count

Two or more of these risk factors results in an estimated 10-year risk between 10 - 20%, which is considered intermediate risk.

Low Risk: If you have fewer than two of the above risk factors, your 10-year risk is estimated to be less than 10%, and you are in the low-risk category.

Another Method Of Categorizing Your Risk

Alternately, you can estimate and categorize your 10-year risk into high (> 20%), intermediate (10-20%), and low (< 10%) risk categories by using an online risk calculator derived from the Framingham study, such as this one from the National Institutes of Health:

• NIH Online Version of the 10-year Risk Calculator

Treatment Goals For LDL Cholesterol Based on Your 10-Year Risk Category

According to the ATP III guidelines, once you know your LDL cholesterol level and your 10-year risk, the treatment goals for your LDL cholesterol would be:

• If you are in the high-risk category, your target LDL level is less than 100 mg/dL. If your measured LDL level is 100 or greater, both lifestyle changes and drug treatment should be initiated. Many experts think the target LDL level should be below 70 mg/dl in high-risk patients. Furthermore, evidence is accumulating that taking statins can reduce heart attacks and mortality in these high-risk patients, even if their LDL cholesterol is low.


• If you are in the intermediate-risk category, your target LDL level is less than 130 mg/dL. If your measured LDL level is greater than 129, lifestyle changes should be initiated. Drug therapy should be strongly considered for LDL levels above 159. Some experts think the target LDL level for intermediate-risk patients should be less than 100 mg/dl.


• If you are in the low-risk category, your target LDL level is less than 160 mg/dL. If your measured LDL level is greater than 159, lifestyle changes are recommended to reduce levels below 160. If your LDL level is greater than 189, drug treatment should be strongly considered.

• Read more about selecting the best cholesterol treatments for high, intermediate and low-risk patients.

What Are the Treatments For Lowering Cholesterol?

Reducing cholesterol levels can be accomplished by lifestyle changes, prescription medication, and with non-prescription products. In order to improve your cardiac outcomes -- which, after all, is the goal of treating cholesterol -- it is important that you and your doctor select the treatment approach that is right for your own condition.

• Read how you and your doctor should choose the treatment that is right for you.

• Read about all the treatments that are available for reducing cholesterol.

• Read about treating cholesterol in children.

_Sources:

_{Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Circulation 2002; 106:3143.}

_{Grundy SM, Cleeman JI, Bairey Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-239.}