Step 5 Find Your Treatment Category - Your Personal Risks And Goals: Heart Disease

Table 8: Cholesterol goals and treatment recommendations

If your risk is…

Your LDL goal is…

Category 1: Very high risk

• Cardiovascular disease (such as detection of narrowed or partially blocked arteries in your heart, neck, legs, or elsewhere; a history of stable or unstable angina, heart attack, stroke, or a heart procedure such as angioplasty or bypass surgery)

And one or more of the following:

• Diabetes or kidney disease

• Severe and poorly controlled risk factors (especially cigarette smoking, but also uncontrolled high blood pressure or family history of heart disease)

• Multiple risk factors for metabolic syndrome (see "Metabolic syndrome"), especially high triglycerides (200 mg/dL or above) and low HDL (below 40 mg/dL)

• A recent heart attack or hospitalization for unstable angina

Below 70 mg/dL. This is an optimal goal that your physician may recommend if you are in this category.

Category 2: High risk

• A history of heart disease (such as heart attack, stable or unstable angina, or a heart procedure such as angioplasty or bypass surgery)

Or

• A heart disease "risk equivalent" (such as diabetes, kidney disease, peripheral artery disease, blocked carotid arteries, or transient ischemic attacks)

And

• Two or more major risk factors (such as smoking, high blood pressure, or family history of heart disease)

And

• A 10-year heart attack risk of more than 20%

Less than 100 mg/dL. Drug therapy is recommended if you have not been able to lower LDL to this level with diet and exercise changes.

Category 3: Moderately high risk

• Two or more major risk factors

And

• A 10-year heart attack risk of 10%–20%

Less than 130 mg/dL. Begin with diet and exercise changes. Your doctor may recommend lowering your LDL to less than 100 mg/dL with medication.

Category 4: Moderate risk

• Two or more major risk factors

And

• A 10-year heart attack risk of less than 10%

Less than 130 mg/dL. Begin with diet and exercise changes if your LDL is 130 mg/dL or above, but consider drug therapy at LDL of 160 mg/dL or above.

Category 5: Low risk

• One major risk factor or none

Less than 160 mg/dL. Begin with diet and exercise changes if your LDL is 160 mg/dL or above, but consider drug therapy at LDL of 190 mg/dL or above.

Adapted from the National Cholesterol Education Program's Adult Treatment Panel III guidelines, 2004