Worrying about cholesterol has become a fact of modern life. And the latest scientific evidence suggests that cholesterol levels once considered ideal may not be low enough to keep heart disease at bay. Indeed, new criteria issued by the National Heart, Lung, and Blood Institute (NHLBI) nearly triple the number of people who should be taking cholesterol-cutting drugs, to almost one-fifth of all adults.


The numbers: The lower the better?

Cholesterol travels through the bloodstream as part of larger particles known as lipoproteins. Treatment for elevated cholesterol levels focuses on LDL (“bad” cholesterol), which tends to dump its cholesterol load into the artery walls. Whether and how much you need to lower your LDL level depends not just on your level, but on your overall coronary risk.

In other words: Even if your LDL level isn’t “bad” (160 and above), other coronary risk factors (ranging from cigarette smoking to diagnosed heart disease) may put you in a category of people who should talk to their doctors about an LDL-lowering treatment plan.

Do You Need To Reduce LDL?
CORONARY-RISK GROUP	CONSIDER REDUCING LDL…	DEFINITELY REDUCE LDL…
HIGH 10-year heart-attack risk about 20%, OR One or more extreme-risk factors	If it’s 70 mg/dl or higher, especially if You have multiple extreme risk factors You have multiple standard-risk factors and a CRP level about 3 mg/l	If it’s 100 mg/dl or higher
MODERATELY HIGH 10-year heart-attack risk of 10% to 20%, AND Two or more standard-risk factors	If it’s 100 mg/dl or higher, especially if you have a high CRP level	If it’s 130 mg/dl or higher
MODERATE 10-year heart-attack risk less than 10%, AND Two or more standard-risk factors	If it’s 130 mg/dl or higher and you have a high CRP level	If it’s 160 mg/dl or higher
LOW No standard risk factors, or one standard-risk factor*	If it’s 160 mg/dl or higher and you have a high CRP level, though the benefit of measuring CRP here is less clear.	If it’s 190 mg/dl or higher
* People in this group usually have less than a 10 percent 10-year risk. Those with higher risk should ask their doctors whether they need more aggressive treatment than shown here.

Find your LDL treatment plan


With drug therapies, treat aggressively—but safely

To reach LDL levels well below 100 mg/dl, high-LDL patients will most likely have to take potent cholesterol-lowering medications known as statins.

While cholesterol drugs are generally safe, their risks rise at higher doses. Moreover, such doses may be unnecessary and unwise. Studies show that the highest doses often provide minimal additional benefit while substantially increasing the chance of adverse effects.

Instead, it often makes sense to add a second medication. A second drug may be appropriate when you have not only a high level of LDL cholesterol but also either a low level of HDL cholesterol (“good” cholesterol, which drags cholesterol out of the arteries) or a high level of triglycerides (fats in the blood that elevate coronary risk). Talk to your doctor.

Coronary Risk Factors
STANDARD RISK FACTORS	EXTREME RISK FACTORS
Cigarette smoking Coronary disease before age 55 in a father or brother Coronary disease before age 65 in a mother or sister Systolic blood pressure of 140 mm Hg or more, diastolic pressure of 90 or more, or use of antihypertensive medication HDL level less than 40 mg/dl (If your HDL is 60 or more, subtract one standard risk factor)	Coronary heart disease Diabetes Peripheral-artery disease Carotid-artery disease Aortic aneurism

Make vital lifestyle changes

Despite the new emphasis on medication, some people with a high LDL can still get by with lifestyle steps alone. And all people who take the drugs must make these changes too, since they’re unlikely to reach their goals otherwise and because the steps protect the heart in many other ways as well.