November 1, 2014
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Cholesterol

 Health Home >> Cholesterol >> Setting goals and tracking your progress 


Setting goals

You and your doctor will work together to set goals for your cholesterol treatment. Having clear goals will make it easier to evaluate the success of your treatment.

Your main treatment goals will be your cholesterol level targets. The specific target number will depend on how high your cholesterol is to start and on your risk of developing heart disease. Your doctor will calculate your heart disease risk level, or you can calculate it here. Regardless of your heart disease risk level and how you are treating high cholesterol, the target for everyone is lowering LDL cholesterol ("bad" cholesterol) by at least 50%.

Here are the usual cholesterol targets:

If your heart disease risk in the next 10 years is... Then you should start treatment... And your cholesterol treatment targets are...
Low (less than 10%) when LDL-C is 5 mmol/L or higher
  • decrease LDL-C by at least 50%
Moderate (10-19%) For most people:
  • when LDL-C is higher than 3.5 mmol/L or
  • when the TC:HDL-C ratio is higher than 5
For men over 50 and women over 60:
  • when hs-CRP*** is higher than 2 mg/L (regardless of whether LDL-C is high)
  • decrease LDL-C by at least 50% or
  • LDL-C less than 2 mmol/L or
  • apoB* less than 0.8 g/L
High** (20% or greater) immediately
  • decrease LDL-C by at least 50% or
  • LDL-C less than 2 mmol/L or
  • apoB less than 0.8 g/L

*apoB = apolipoprotein, a protein that is part of LDL-C and VLDL-C and can cause inflammation in the blood vessels
**The high risk group also includes people with diabetes or atherosclerosis-related diseases (e.g., heart disease, stroke, peripheral arterial disease)
*** hs-CRP (C-reactive protein) is a protein that the liver makes when there is inflammation in the body. It's also called a marker of inflammation, and can be measured with an hs-CRP (high-sensitivity C-reactive protein) test, also called a hs-CRP test.

The targets listed in the table are just a guideline - your doctor may recommend that you aim for even lower targets (for example, you may need to go beyond a 50% reduction in your LDL-C). When it comes to LDL cholesterol levels, the general rule is "the lower the better". For every 1.0 mmol/L reduction in LDL cholesterol, your risk of developing certain complications of heart disease (heart disease-related death and heart attack) goes down by 20% to 25%.

While LDL cholesterol is the most important target, your doctor may also set other "secondary" targets, especially once you reach your LDL-C target, such as:

Secondary targets Usual target level
total cholesterol to HDL cholesterol ratio (TC:HDL-C ratio) less than 4.0
triglycerides less than 1.7 mmol/L
hs-CRP less than 2.0 mg/L
non-HDL-cholesterol (TC minus HDL-cholesterol) less than 3.5 mmol/L
apoB to apoAI ratio (apoB is part of LDL-C and VLDL-C, and apo AI is part of HDL) less than 0.80

Although triglycerides are measured in a cholesterol test, the Canadian Cholesterol Guidelines no longer recommend a treatment target for them. But a triglyceride level of 10.0 mmol/L or more should be treated because it increases the risk of a health condition called pancreatitis (inflammation of the pancreas). The ideal level for triglycerides is less than 1.5 mmol/L.

Your doctor may also recommend other treatment goals, such as:


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