October 25, 2014
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Cholesterol


How can I reduce my risk?

Treating high cholesterol

The usual treatment options for high cholesterol are healthy lifestyle changes, used alone or in combination with medications.

  • Learn more about healthy lifestyle changes. Healthy lifestyle changes can help address your modifiable risk factors (things you can change) for heart disease. But there are also non-modifiable risk factors (things you can't change). Medications can help offset some of the risk caused by these factors.

  •  
  • Learn more about medications. Side effects are a common obstacle to successful treatment, and higher medication doses usually cause more side effects. Find out how to manage side effects.

The usual goal of treatment is to lower your LDL cholesterol ("bad cholesterol") as much as possible - the lower, the better. Each reduction in LDL cholesterol is associated with a large drop in the risk of heart attacks and dying from heart disease. For every 1.0 mmol/L reduction in LDL cholesterol, this risk goes down by 20% to 25%.

Talk to your doctor to find out if your treatment plan is helping you get your cholesterol down low enough.

Setting goals

Do you know your treatment goals? Having clear goals will make it easier to evaluate the success of your treatment.

Your main treatment goals are your cholesterol level targets. These targets 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 total cholesterol:HDL 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
  • decrease 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)
    *** 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 hsCRP (high-sensitivity C-reactive protein) test, also called a CRP test.

    The targets listed in the table are just a guideline - your doctor may recommend that you aim for even lower targets. When it comes to LDL cholesterol levels, the general rule is "the lower the better." This means your doctor may recommend going beyond the 50% reduction recommended in the table. For every 1.0 mmol/L reduction in LDL cholesterol, your risk of developing certain complications of 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 in addition to LDL cholesterol, 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/dL
    non-HDL-cholesterol (total cholesterol minus HDL-cholesterol) less than 3.5 mmol/L
    apoB:apoAI ratio (apoB is part of LDL-C and VLDL-C, and apo AI is part of HDL-C) less than 0.80

    Tracking your progress

    The key to evaluating the success of your treatment is to track your progress, including:

    • your treatment goals
    • your treatment plan (e.g., your medications and healthy lifestyle changes)
    • how your cholesterol levels and other targets (such as weight, blood pressure, and blood sugar) change over time

    Use these tools to help you:

    1. Doctor discussion guide: This helps you prepare for your doctor's visit to discuss your treatment goals, expectations, and progress, and how to minimize your risk of side effects.
    2. Cholesterol diary: This lets you keep track of your cholesterol targets, medications, food, exercise, and test results.

    Here are a few questions to ask yourself as you use these tools:

    1. Do I know what I'm trying to achieve with my cholesterol treatment? In other words, do I know which tests my doctor is following, and what targets I am aiming for?
    2. Do I understand my treatment plan, including which medications I should be taking, how to use them, and what lifestyle changes to make?
    3. Do I know how often I should be having my cholesterol checked? Do I need any other medical tests?
    4. Do I know how close I am to meeting my treatment goals?
    5. Do I know how to reduce my risk of side effects?

    If the answer to any of these questions is "No," talk to your doctor about your treatment goals and how to evaluate the success of your treatment.

    Reaching your treatment goals

    Why is it so important that I treat my high cholesterol?

    Treating high cholesterol can help reduce your risk of serious cholesterol-related complications, such as:

    • heart disease
    • heart attacks
    • strokes
    • angina (chest pain)
    • peripheral vascular disease (circulation problems)

    Effective cholesterol treatment could even save your life. Research shows that the more you lower your cholesterol, the lower your risk of developing certain complications of heart disease (heart attacks and heart disease-related death).

    What healthy lifestyle changes can help lower my cholesterol?

    The following healthy lifestyle changes can help keep your cholesterol under control:

    • reaching and maintaining a healthy body weight
    • eating a healthier diet
    • getting regular exercise
    • quitting smoking
    • moderating your alcohol intake

    Learn more about these healthy lifestyle changes.

    What medications can help lower my cholesterol?

    Medications for high cholesterol include:

    • statins
    • cholesterol absorption inhibitors
    • resins
    • fibrates
    • niacin

    Learn more about these medications.

    Taking medication

    This section deals with some common issues that you may have during medication treatment. To learn more about specific medications, click here.

    Setting treatment expectations

    If you start medication therapy, you and your doctor will work together to set goals for your treatment. Having clear goals will make it easier to evaluate the success of your treatment. The main goal for cholesterol medication treatment is to reach certain target cholesterol levels. In general, the lower your cholesterol levels, the better. The recommended target for everyone at risk of developing heart disease is to reduce LDL cholesterol (the "bad" cholesterol) by at least 50% from their starting cholesterol level.

    Talk to your doctor what your cholesterol target levels should be. To learn more, read "Setting goals."

    Managing side effects

    Side effects and concerns about side effects are a common roadblock to successful treatment with cholesterol medications. Fortunately, most side effects can be managed, and there are steps you can take to reduce the impact of side effects you may experience:

    • Ask your doctor if you are starting on the most appropriate dose of your cholesterol medication. Higher doses generally cause more side effects. Reducing the dose can help with many cholesterol medication side effects. You may need to try different doses (as recommended by your doctor) until you find the dose that controls your cholesterol without causing bothersome side effects.
    • Know which side effects to watch for - to learn more about possible side effects from cholesterol medication, see "Using medication as directed" or read the drug factsheet for your medication. Ask your doctor or pharmacist what to do if side effects do occur.
    • Take your medication exactly as directed. Follow instructions from your doctor or pharmacist about what to do if you miss a dose so that you don't accidentally take a double dose.
    • Be on the lookout for side effects when you first start the medication and when your dose is increased.

    Sticking with your medication

    It can be hard to stick with your medication, for many reasons:

    • High cholesterol is usually a silent disease, so when you take medication to lower your cholesterol, you can't feel it working.
    • You may suffer from side effects (see above) from your medication.
    • You may find it hard to remember the medication or how to fit it into your lifestyle.
    • You may find it hard to keep motivated about taking the medication (especially if you're not having regular follow-up appointments to check your progress).

    For tips on how to deal with these issues, read "Staying motivated."

    Talking to your doctor

    Without proper treatment, high cholesterol can cause serious complications, such as heart disease, heart attacks, strokes, angina (chest pain), circulation problems, and death.

    Your doctor can help you set goals for your treatment, evaluate the success of your treatment, and minimize your risk of side effects. There is a link between dosing and side effects: higher doses tend to cause more side effects. Your doctor can help you reduce your side effect risk by making sure you're on the appropriate dose of your medication.

    To help you prepare for your visit, print the Doctor discussion guide, fill out as much information as you can, and bring it to your doctor's visit.

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