Medical Definition of Cholesterol guidelines
Cholesterol guidelines: The guidelines on cholesterol for adults. Controlling blood cholesterol levels may decrease the risk of heart attack and stroke. The National Institute of Health, the American Heart Association and the American College of Cardiology publish guidelines to help physicians and patients with this risk reduction. The most recent consensus in 2013 recommended the following:
Major recommendations in the past included:
- High and Very High Risk People: For high-risk patients, the overall goal remains an LDL level of less than 100 mg/dL. But for very high-risk patients whose LDL levels are already below 100 mg/dL, there is also an option to use drug therapy to go below 70 mg/dL goal.
High-risk people are those who have coronary heart disease or disease of the blood vessels to the brain or extremities, or diabetes, or multiple (2 or more) risk factors (for example, smoking, hypertension) that give them a greater than 20 percent chance of having a heart attack within 10 years.
Very high-risk people are those who have cardiovascular disease together with either multiple risk factors (especially diabetes), or severe and poorly controlled risk factors (such as continued smoking), or metabolic syndrome (a constellation of risk factors associated with obesity including high triglycerides and low HDL). Patients hospitalized for acute coronary syndromes such as heart attack are also at very high risk.
- Moderately High-Risk People: For moderately high-risk patients, the goal remains an LDL under 130 mg/dL, but there is a therapeutic option to set a lower LDL goal of under 100 mg/dL and to use drug therapy at LDL levels of 100 - 129 mg/dL to reach this lower goal.
Moderately high-risk patients are those who have multiple (two or more) risk factors for coronary heart disease together with a 10 to 20 percent risk of heart attack within 10 years.
For high-risk or moderately high-risk patients, the report advises that the intensity of LDL-lowering drug therapy be sufficient to achieve at least a 30 to 40 percent reduction in LDL levels. This can be accomplished by taking statins or by combining lower doses of statins with other drugs (bile acid resins, nicotinic acid [Niacor, Niaspan, Slo-Niacin], or ezetimibe [Zetia]) or with food products containing plant stanol/sterols.
- Lower/Moderate Risk People: The update did not revise recommendations for lower risk persons: those with moderate risk (2 or more risk factors plus an under 10 percent risk of a heart attack in 10 years) or those with 0 to 1 risk factor.
According to the report, the absolute benefits for people at the lower levels of risk are less clear cut and the recent clinical trials do not suggest a modification of treatment goals and cut points.
Lifestyle changes (good nutrition, physical activity, and weight control) continue to be very important in cholesterol management. Lifestyle changes also have the potential to reduce cardiovascular risks through several mechanisms beyond the lowering of LDL cholesterol.
Specific LDL goals are now less important. The updated (2013) guideline recommends statin therapy for the following groups:
- People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for having a heart attack or stroke within 10 years.
- People with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).
- People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
- People with Type 1 or Type 2 diabetes who are 40 to 75 years old.
Quick GuideCholesterol Levels: What the Numbers Mean
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