What Cholesterol Level Needs Medicine

Are Home Cholesterol Testing Kits Accurate

The answer is yes if the tests are labeled CDC-certified. This means that the contents have been approved by the Cholesterol Reference Method Laboratory Network, a group that works with test makers, laboratories and the Centers for Disease Control and Prevention to make sure tests are accurate.

For home tests, you will still need to fast for 12 hours and to obtain blood for testing. Some kits come with packages for mailing to a lab for results. Other kits have a monitor so you can get the results at home. The cost of such home kits vary.

How Often Should I Get A Cholesterol Test

When and how often you should get a cholesterol test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger:

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older:

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

When Is Medication Typically Required To Manage High Cholesterol

Medication is typically recommended when:

• your cholesterol levels are high enough to increase your risk for cardiovascular disease
• you have an LDL level greater than 190 milligrams per deciliter
• you have diabetes or are otherwise considered high risk for cardiovascular disease, and you have an LDL level greater than 70 mg/dL

A doctor will calculate your cardiovascular disease risk score to show your risk for developing a heart attack or stroke over 10 years. If the score is greater than 5 percent, theyll recommend a medication.

You can calculate your cardiovascular disease risk score online using the American College of Cardiologys risk estimator.

Having a triglyceride level greater than 200 mg/dL also puts a person at higher risk for cardiovascular disease. A triglyceride level of greater than 885 mg/dL will prompt a doctor to prescribe a medication, because you would be at an additional increased risk for pancreatitis.

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Questions To Ask Your Doctor

If youâre not sure why your doctor prescribed statins to lower your cholesterol, ask at your next appointment.

• Why do you think I need a statin?
• What will it do for me?
• Based on my specific health, what might I gain from taking one and what are my risks?
• Could a statin interact with any medicines or supplements Iâm taking?
• When will I know if this drug is working?
• Can I take a supplement instead of — or along with — a statin to lower my cholesterol?
• What supplements or treatments will ease side effects?

Miller tells his patients to look at statins like a daily vitamin to boost health. “In many ways, thatâs what it is,” he says, “and itâs the only one that we know that works so well to improve cholesterol and lower cardiovascular risk.”

Michael Miller, MD, director, the Center for Preventive Cardiology, University of Maryland Medical Center, Baltimore.

Patrick McBride, MD, MPH, director, preventive cardiology program and cholesterol clinic, the University of Wisconsin School of Medicine and Public Health, Madison, Wis.

David Kiefer, MD, assistant clinical professor of medicine, University of Arizona, Tucson.

American Heart Association, Atlanta. Diet and Exercise Key for Treating High Triglycerides: New AHA Statement

Current Opinion in Lipidology, Lowering LDL-Cholesterol Through Diet: Potential Role in the Statin Era, 2011.

Consumer Reports: Heart Supplements: Proceed with Caution.

FDA: “Important safety label changes to cholesterol-lowering statin drugs.”

Who Should Be Treated

In a sense, everyone. That’s because no cholesterol level is too good. But people with unhealthy levels should work hard to improve, while those with ideal results can afford to relax a bit. Table 1 shows the goals established by the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.

Cholesterol is a crucial determinant of cardiovascular health, but it’s only one. In fact, smoking is even more dangerous than unhealthy cholesterol levels, and high blood pressure, diabetes, and lack of exercise are nearly as harmful. Because each risk factor adds to the harm of others, people with the most risk need the most vigorous treatment. Table 2 shows how an individual’s risk profile influences the choice of therapy.

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Controversy Surrounding Category 4

People who are in Categories 1 to 3 undeniably have a very high risk of developing cardiovascular problems, and they clearly need aggressive therapy to reduce that risk. Category 4, on the other hand, was established to find those individuals who are at an elevated risk, but a risk that is somewhat lower, and somewhat less obvious, than in the first three categories. Defining who ought to be placed into Category 4, therefore, is inherently a somewhat arbitrary process and will naturally be open to criticism.

There are two general kinds of criticism being made about Category 4. The first claims that Category 4 includes too many people. These critics point out that the risk calculator provided by the NHLBI places a lot of emphasis on age. For this reason, many people over the age of 60 will find themselves at or very near the 7.5% cutoff.;Furthermore, say these critics, 10-year risk of 7.5% itself is too liberal.;Treatment recommendations in the past tended more toward a cutoff of 10%. Arbitrarily lowering the treatment cutoff to 7.5%, they say, adds too many people to the treatment list.

Such a controversywhether Category 4 includes too many or too few peopleis inherent to any recommendation whose cutoff is determined arbitrarily by a panel of experts.

Why Cholesterol Matters For Women

Reviewed By:

Erin Donnelly Michos, M.D., M.H.S.

Ah, cholesterol and triglycerides. We hear about them all the time. Even foods that might seem good for you on the surface, like fruit-filled yogurt or bran muffins, can contribute to abnormal levels if they contain too much saturated fat or refined sugar, says Erin Michos, M.D., associate director of preventive cardiology at the Ciccarone Center for the Prevention of Heart Disease.

Whats more, many women are at risk for high cholesterol and dont realize it. Approximately 45 percent of women over the age of 20 have a total cholesterol of 200 mg/dl and above, which is considered elevated but a survey by the American Heart Association found that 76 percent of women say they dont even know what their cholesterol values are, Michos says.

Scarier still: Triglycerides, a type of blood fat typically measured alongside cholesterol, are even more risky in women compared with men. This is a problem because womens cholesterol levels can fluctuate quite a bit after menopause and tend to increase with age, putting us at greater risk of heart disease and stroke. Knowing your cholesterol numbers and how to control them is a big step toward staying healthy.

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Statin Use Among Children

Several statins are approved by the FDA for use in children.; Some are approved for children over 8 years of age and others for children at least 10 years of age.; Approved statins include: atorvastatin , fluvastatin , lovastatin , pravastatin , rosuvastatin , and simvastatin .

Statins are usually used to treat children with genetic conditions that cause hyperlipidemia, which is an excess of lipids like cholesterol and triglycerides in the blood.; Short term studies in children show some improvement in measures like LDL cholesterol, blood flow, and thickness of the artery walls.; However, statin research has not studied children for more than 2 years, so we dont know the long-term risks of statins for children, or if treatment in childhood actually improves health over a longer period of time or into adulthood.;We also dont know which of the statins work better in children.

What Are Statins Who Are They For And How Do They Work

Statins are a type of cholesterol medication used to lower bad cholesterol and lower risk for cardiovascular disease. They lower cholesterol by blocking your bodys ability to use an enzyme needed to make cholesterol.

Statins are for anyone who has high cholesterol levels and who previously had a heart attack or stroke or who is at high risk for a cardiovascular event.

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What Affects My Cholesterol Levels

A variety of things can affect cholesterol levels. These are some things you can do to lower your cholesterol levels:

• Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise. Saturated fat is the main problem, but cholesterol in foods also matters. Reducing the amount of saturated fat in your diet helps lower your blood cholesterol level. Foods that have high levels of saturated fats include some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.
• Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL cholesterol, total cholesterol, and triglyceride levels. It also raises your HDL cholesterol level.
• Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL cholesterol and raise HDL cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.
• Smoking.Cigarette smoking lowers your HDL cholesterol. HDL helps to remove bad cholesterol from your arteries. So a lower HDL can contribute to a higher level of bad cholesterol.

Things outside of your control that can also affect cholesterol levels include:

Do Statins Cause Muscle Pain And Weakness

Muscle aches occur in about 10 percent of people who take statins. Its the most common side effect of statins, but another way to look at it is that nine out of 10 patients dont experience it at all.When patients do have muscle pain:Actual muscle damage occurs in only 1 in 10,000 patients. In the rare event that muscle damage occurs, it is almost always reversible. To correct it while still protecting you from heart attack or stroke, we can adjust your medication or try a different statin. There also are many strategies to effectively manage muscle symptoms while continuing to take your medication.If you experience muscle pain while taking a statin, dont stop taking it without first talking with your doctor. For almost all patients, were able to find an effective medication that the body can tolerate. If you simply cant tolerate statins, there are other cholesterol medications we can prescribe.

• The symptom is often resolved by adjusting the medication dosage or switching to a different statin.
• Occasionally, the statins have to be stopped altogether.
• When the medication is switched or stopped, the symptoms go away and there is no damage to the muscle.

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Cholesterol Levels In Dialysis Patients

In a study of dialysis patients, those with higher cholesterol levels had lower mortality than those with low cholesterol.51 Yet the authors claimed that the inverse association of total cholesterol level with mortality in dialysis patients is likely due to the cholesterol-lowering effect of systemic inflammation and malnutrition, not to a protective effect of high cholesterol concentrations. Keeping an eye on further funding opportunities, the authors concluded: These findings support treatment of hypercholesterolemia in this population.

What Else To Keep In Mind

Whether or not you choose to take a statin, lifestyle changes still matter.

“About 80% to 90% of the time, heart disease is preventable through modifiable risk factors,” Steinbaum says. She notes that eating a healthy diet , being active, not smoking, and keeping your weight down are all key.

Still, there are other things you canât change, like your age and your genes. Although diet and exercise are a must, they arenât enough for everyone. Still, overhauling your habits might mean that you can take less medication, which can mean a lower risk of side effects.

Still on the fence? Talk to your doctor, and ask for more information that may help you decide.

Make sure you talk about ârisk factorsâ that are not part of the latest risk calculator from the AHA and ACC. Those might include your family history, C-reactive protein levels , or a personal history of gestational diabetes .

Your doctor may consider other things, too. Steinbaum sometimes orders imaging tests to look for calcification in the arteries or measure the thickness of the carotid artery, which carries blood from the heart to your brain, before she decides whether to recommend a statin for a particular patient. But those arenât routine tests.

Although statins are still a go-to medicine, there is no one-size-fits all prescription. And if they donât help you enough , or you canât take them because of side effects, there are also other types of cholesterol-lowering medicines.

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Cholesterol Targets Are Back

Much to the delight of physicians, concrete LDL-C targets have been reintroduced into this version of the guidelines. For individuals with atherosclerotic cardiovascular disease who are at very high risk of cardiac complications, drug therapy beyond statins is recommended to achieve a target LDL-C of 70 mg/dl.

The first addition beyond high-intensity statins would be the now generic ezetimibe, a cholesterol-lowering drug that works by preventing the absorption of cholesterol in the intestine. If that does not do the trick, the injectable PCSK9 inhibitors are considered a reasonable next step, with the caveat that the drugs are expensive and their long-term safety beyond three years is not well established. However, since the guidelines were finalized, one of the two companies that makes PCSK9 inhibitors has lowered the list price. This may ultimately help make these potent cholesterol reducing drugs more cost-effective.

The same algorithm as above is recommended for otherwise healthy people whose LDL-C is greater than or equal to 190 mg/dL. In this case, however, the target is 100 mg/dL instead of 70 mg/dL, presumably because there is no evidence of actual atherosclerosis.

In people 40 to 75 years of age with diabetes who have an LDL-C greater than or equal to 70 mg/dL, a moderate-intensity statin is recommended. If there are additional risk factors or the person is 50 years or older, then a high-intensity statin is considered reasonable.

Is There Anything Else I Need To Know About My Cholesterol Levels

High cholesterol can lead to heart disease, the number one cause of death in the United States. While some risk factors for cholesterol, such as age and heredity, are beyond your control, there are actions you can take to lower your LDL levels and reduce your risk, including:

• Eating a healthy diet. Reducing or avoiding foods high in saturated fat and cholesterol can help reduce the cholesterol levels in your blood.
• Losing weight. Being overweight can increase your cholesterol and risk for heart disease.
• Staying active.;Regular exercise may help lower your LDL cholesterol levels and raise your HDL cholesterol levels. It may also help you lose weight.

Talk to your health care provider before making any major change in your diet or exercise routine.

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How Do I Know If My Cholesterol Is Too High

There are no symptoms that can warn you when your cholesterol level is high. You can have high cholesterol and never know it. A lipid panel blood test is the only way to determine whether or not you have high cholesterol.

It is generally recommended that men and women over 20 years of age should have their cholesterol levels checked every 5 years. However, if your test results are outside of the recommended range, you should check them more often. Other factors related to your health, your family medical history and your lifestyle will also affect how often you should have your cholesterol levels checked. As always, talk to your doctor about the frequency that is best for you.

Is High Dose Statin Therapy Better Than Low Dose

High dose statins are superior for patients with acute or substantial arterial inflammation, like patients who have had a recent heart attack.; This was shown in the A to Z trial and in the Prove It trial . However, the 2008 SEARCH trial showed that high dose statin therapy was not superior to low dose for lowering major vascular events and all-cause mortality . . .;in patients with stable heart disease . So once inflammation stabilizes, it seems reasonable to decrease the statin dose .

The current cholesterol guidelines recommend all patients with CV risk receive a high-dose statin in order to lower LDL-C more than 50%. However, we have the capability of doing specialized blood work to determine the real source of each patients cholesterol problem . Doubling the dose of a statin only offers an additional 5-10% lowering in LDL cholesterol , so instead of prescribing a high-dose statin and increasing the risk of potential side effects, we often prescribe low-dose statins and then add on Zetia if needed. Zetia is a non-statin, well-tolerated medication that can further lower cholesterol by shutting down the absorption of cholesterol in the intestines . In the IMPROVE-IT trial, Zetia lowered cardiovascular events when added onto statin therapy , so we have outcome data to back it up. This trial also indicated that the lower the LDL cholesterol, the better .

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Cholesterol Chart For Adults

According to the 2018 guidelines on the management of blood cholesterol published in the Journal of the American College of Cardiology , these are the acceptable, borderline, and high measurements for adults.

All values are in mg/dL and are based on fasting measurements.

Total cholesterol

Your doctor may recommend a plan of treatment for high cholesterol that includes lifestyle modifications and potentially medication. This will vary based on factors like other medications you may be taking, your age, sex, and general health.

Here are some medications more commonly prescribed for high cholesterol:

Medications can also be used to treat contributing factors to cholesterol like triglycerides. These may be used in addition to some of the medications above.