LDL Cholesterol: How Low Should You Go?
If you’re working to reduce your low-density lipoprotein (LDL) cholesterol level, congratulations. Your efforts will pay off in the long run. Reducing LDL, or “bad,” cholesterol can help prevent heart attack and stroke. It can also stop—or even reverse—plaque buildup in the arteries, and help you live a longer life. But how low should you go with your LDL level?
Assessing Your Heart Disease Risk
It’s important to talk with your doctor to set a goal for your LDL level. In general, the higher your risk for heart disease, the lower you want your LDL level. That’s because high LDLs in the blood increase plaque buildup in the arteries and can lead to heart attack and stroke.
Risk factors for heart disease include:
High blood pressure (≥140/90 mm Hg), or taking medication for high blood pressure
Low HDL, or “good,” cholesterol (<40 mg/dl)
Family history of premature heart disease (men younger than age 55, and women younger than age 65)
Age (men older than 45, and women older than 55)
In addition to heart disease risk factors, LDL targets take into consideration your estimated risk of developing heart disease or having a heart attack in the next 10 years. Your 10-year risk (measured in percentages) can be estimated using the Framingham Point Score. Your doctor can help determine this risk. You can also find a scoring sheet online.
Identifying LDL Goal Based on Risk Level
To help pinpoint your LDL level goal, national cholesterol guidelines group people into different risk categories. They include:
Category 1: Very High Risk. You are in the very high risk category if you have had a recent heart attack, have metabolic syndrome (a cluster of factors that raise your risk for heart problems), or have cardiovascular disease with other poorly controlled risk factors, such as continued smoking. If you are at very high risk, your doctor may want your LDL level to be less than 70 mg/dl.
Category 2: High Risk. If you are in the high-risk category, you already have heart disease, diabetes, or a 20% or greater chance of developing heart disease or having a heart attack in the next 10 years. If you are at high risk, you should aim to get your LDL level below 100 mg/dl.
Category 3: Moderately High Risk. You are borderline high risk if you have two or more risk factors and a 10% to 20% chance of developing heart disease or heart attack in the next 10 years. If you fall into this category, keep your LDL level below 130 mg/dl.
Category 4: Moderate Risk. You are at moderate risk if you have two or more risk factors and less than a 10% risk for heart disease or heart attack in the next 10 years. Try to keep your LDL level below 130 mg/dl.
Category 5: Low Risk. If you are at low risk, you have zero or one risk factor. Make sure your LDL level stays below 160 mg/dl.
Take Charge of Your LDL
Based on your level of risk, your doctor will develop a treatment plan to lower your LDL level. This may include prescribing cholesterol-lowering medication. But you can help take control of your cholesterol, no matter what your risk level, by living a healthy lifestyle. Steps that can lower LDL cholesterol include eating a healthy diet that’s low in saturated fat and cholesterol, reaching and maintaining a healthy weight, keeping your blood sugar under control, and getting regular exercise. It’s also important to not smoke.
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