By Julian Booker, MD
Statistics tell a story about groups of patients, not a single patient (you). What statistics can do is provide your physician with information about what therapies will probably be helpful for you. These statistics help your doctor identify therapies that may help you live longer and live better. When it comes to preventing coronary artery disease, the foundation of medication therapy is based upon three pillars:
1) Improving blood pressure
2) Controlling blood glucose
3) Outstanding cholesterol numbers
For the purpose of this post, we will focus on the cholesterol. Below, I have included the classification of LDL cholesterol levels as determined by the Adult Treatment Panel 3’s (ATP 3):
LDL Cholesterol –
100-129 Near optimal
130-159 Borderline high
>190 Very high
For those of you with diabetes or prior heart disease, you already know that your cardiologist is like a dog with a bone when it comes to your LDL…they just can’t seem to leave it alone. Some of you have probably wondered why but have probably been too afraid to ask so. Next time when you get a copy of your labs, your cholesterol will be broken down into at least two different types (1) the good cholesterol or high density lipoprotein (HDL) and (2) the bad cholesterol or low density lipoprotein (LDL). The LDL is a great target for you and your doctor to follow because high levels are associated with heart disease. Also we actually have medicines that can make a real difference with LDL. These two things make it a very good target for your doctor.
It is important to note that LDL is a moving target. Your LDL value may be OK for you but not OK for your sister. There are many factors that go into determining what value is most appropriate for you. I will try to make this convoluted subject as straight forward as I can so be patient with me.
As a general rule of thumb, lower LDL levels are better for your heart. The higher your risk for heart disease, the lower we want your LDL to be. If you already have coronary artery disease OR a condition that puts you at equal risk (diabetes, symptomatic carotid artery disease, abdominal aortic aneurysm, peripheral artery disease) OR a 10-year Framingham 10-year risk of greater than 20%* read carefully, this is important. If any of the above describe you then you are at HIGH RISK for heart attack and you have work to do to lower your cholesterol. Your target LDL is less than 100 mg/dl. If you have any of the above AND at least two more risk factors for heart disease like high blood pressure, age (greater than 45 for men and greater than 55 for women, smoking, family history of early heart disease, metabolic syndrome) then you are at the HIGHEST RISK and your target LDL is less than 70 mg/dl. To be honest, once you cross into the HIGH RISK category, many cardiologist will automatically start shooting for 70 mg/dl.
If you have two risk factors for heart disease or your Framingham 10-year risk* is between 10-20% I want your LDL to be less than 130 mg/dl. If you have less than two risk factors then we are fairly liberal. In this case your LDL should be less than 160 mg/dl. No matter what your level of LDL, it may be reasonable to consider diet and exercise first. Unfortunately with these very low target LDLs, most of the time lifestyle changes are not enough.
Statin medications have gotten a pretty bad reputation and most of it is unfair. Unfortunately, patients are almost universally hesitant to take them. Television commercials about the dangers of statins have not helped. However, if you have heart disease, don’t make your doctor prove why you NEED a statin, make him prove why you DON’T NEED a statin. It may very well save your life.
#LowerIsBetter or #myheart
* visit myheart.net to have your 10-year Framingham risk calculated for you
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