The U.S. National Cholesterol Education Program's (NCEP) recommendations for treatment with medicine are based on your cholesterol levels and your risk of having a heart attack.1
Knowing your risk is important to determine whether you should start taking medicine right away or whether you can first try lifestyle changes to lower your cholesterol.2
Highest risk (category I)
People who are at high risk have more than a 20% chance of having a heart attack in 10 years. They have coronary artery disease (CAD), have had a heart attack, have stable or unstable angina, or have had angioplasty or bypass surgery. This category also includes people who have diseases or conditions that are considered equally as serious as CAD. These are peripheral arterial disease, abdominal aortic aneurysm, transient ischemic stroke or ischemic stroke, and diabetes.
Moderately high risk (category II)
People who are at moderately high risk have a 10% to 20% risk of having a heart attack in 10 years.
Moderate risk (category III)
People who are at moderate risk have less than a 10% risk of having a heart attack in 10 years.
Lower risk (category IV)
People who are at lower risk do not have coronary artery disease (CAD) and have one or no risk factors for heart attack.
Find your risk category in the following table, then use the table to find the recommended treatment for your current LDL level. If your LDL level is below the goal for your risk category, NCEP still recommends that you follow a heart-healthy diet.
| LDL goal with treatment (mg/dL) | If your LDL level is: | |
|---|---|---|
| Category I (highest risk) | Less than 100 Consider using medicine to lower LDL to 70, especially if you have coronary artery disease (CAD) and you also have diabetes, acute coronary syndrome, or metabolic syndrome or you smoke cigarettes. |
100 or above: Begin TLC diet and medicines. |
| Category II (moderately high risk) | Less than 130 |
130 or above: Begin TLC diet and medicines. 100 to 129: Consider medicines. |
| Category III (moderate risk) | Less than 130 |
130 or above: Begin TLC diet. 160 or above: Consider medicines. |
| Category IV (lower risk) | Less than 160 |
160 or above: Begin TLC diet. 190 or above: Consider medicines. 160 to 189: Medicines are optional. |
References
Citations
Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]
Grundy SM, et al. (2001). Executive summary of the 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). JAMA, 285(19): 2486–2497.
Credits
| Author | Ralph Poore |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Pat Truman |
| Associate Editor | Terrina Vail |
| Primary Medical Reviewer | Caroline S. Rhoads, MD - Internal Medicine |
| Specialist Medical Reviewer | Neil J. Stone, MD, FACC, FACP - Internal Medicine, Cardiology |
| Last Updated | July 20, 2006 |
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