When Will I Have To Take Cholesterol Lowering Medications?

Question: When Will I Have To Take Cholesterol Lowering Medications?

Answer: Not everyone starts out taking cholesterol-lowering medications when first diagnosed with high cholesterol. Your healthcare provider may decide to place you on medication depending on how high your cholesterol -- especially your bad cholesterol (LDL) -- is and how many risk factors you have for coronary heart disease.

If your cholesterol is only slightly elevated and you are relatively healthy, your healthcare provider may have you try modifying your lifestyle before decision is made to place you on medication. Changes in your lifestyle may include:

• modifying your diet
• smoking cessation
• exercising

Your healthcare provider may try this for a few months in order to see how far these lifestyle changes can lower your cholesterol before placing you on medication.

If your cholesterol does not budge much with lifestyle modifications, or if your cholesterol was dangerously high to begin with, you may need medication for it. According to the guidelines designed by the National Cholesterol Education Program for lowering high cholesterol, your LDL cholesterol goal should be less than 160 mg/dL if you are relatively healthy.

What Happens If You're At a Higher Risk For Heart Disease?

If your cholesterol is high, or if you have certain risk factors and are not at LDL cholesterol level you are supposed to be, your healthcare provider may decide to prescribe lifestyle changes AND medications to lower your cholesterol.

If you are at a high risk for heart disease, or already have heart disease, your healthcare provider may be a little more aggressive in lowering your cholesterol. These conditions may include:

• Diabetes
• Peripheral vascular disease
• Carotid artery disease
• Angina
• Previous heart attack

In this case, your healthcare provider may initiate lifestyle changes and medication to get your LDL cholesterol below 100 mg/dL. If you have one or more of these, your healthcare provider may shoot for an even lower LDL cholesterol goal (below 70 mg/dL).

Even if you don’t have a history of heart disease, certain risk factors could also place you at risk of having heart disease compared to someone who is healthy. These risk factors include:

• Smoking
• Low “good” cholesterol (HDL less than 40 mg/dL)
• High blood pressure (140/90 mm Hg or on medications to control blood pressure)
• Age (females greater than or equal to 55 years of age, males greater than or equal to 45 years)
• A family history of premature heart disease (a female first degree relative younger than 65 years or age, or a male first degree relative younger than 55 years of age).

You can assess your risk for heart disease by using the Framingham risk calculator, which takes into account all of the risk factors listed above. Depending on how many of these risk factors you have, and your 10-year risk for developing coronary heart disease, your healthcare provider may decide to place you on medication:

• If you have zero or one risk factors and your 10-year risk for heart disease is less than 10%, your healthcare provider will want your LDL cholesterol goal to be less than 160 mg/dL. If your LDL cholesterol is greater than 190 mg/dL, your healthcare provider may decide to place you on medication and lifestyle changes.
• If you have two or more risk factors and your 10-year risk for heart disease is less than 10%, your healthcare provider will want your LDL cholesterol goal to be less than 130 mg/dL. If your LDL cholesterol is greater than 160 mg/dL, he may want to take cholesterol-lowering medications.
• If you have two or more risk factors and your 10-year risk for developing heart disease is 10% to 20%, your healthcare provider will want your LDL cholesterol to be around 130 mg/dL. If you fit into this category, you are at a higher risk for heart disease and your healthcare provider may want to begin cholesterol-lowering medications even if your cholesterol is a little higher than 130 mg/dL.

If you are prescribed medication to lower your cholesterol, it is not the end of the world. High cholesterol is the most modifiable risk factor for heart disease. By getting your cholesterol levels low -– especially your LDL cholesterol –- you will be able to help prevent heart disease later on in life.

_Source:

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (PDF), July 2004, The National Institutes of Heath: The National Heart, Lung, and Blood Institute.