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    Heart Disease and Lowering Cholesterol

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    How Is High Cholesterol Treated? continued...

    Doctors determine your "goals" for lowering LDL based on the number of risk factors you have for heart disease.

    Major risk factors include: age (men 45 years and older, women 55 years and older), cigarette smoking, high blood pressure, an HDL less than 40 mg/dL, family history of premature heart disease in a first-degree male relative (father or brother) less than age 55 and first-degree (female) relative less age 65.

    • If you have 0-1 risk factor for heart disease, you are at low-to-moderate risk. Generally, lifestyle changes are effective in keeping the cholesterol in check.
    • If you have 2 or more risk factors for heart disease, you are at moderate risk, depending on what heart disease risk factors you have. Your doctor may recommend lifestyle changes, but most people require cholesterol-lowering drugs, along with an appropriate diet and exercise program.
    • If you have known heart disease, diabetes, or multiple risk factors, you are at high risk. Most people in this group will require a combination of cholesterol-lowering drugs and lifestyle changes to control their cholesterol levels.

    LDL cholesterol goals include the following:

    • Category I, Highest Risk (ten-year risk greater than 20%*): your LDL goal is less than 100 mg/dL. For those with a very high risk (those who have had a recent heart attack, those with cardiovascular disease or peripheral artery disease combined with diabetes or poorly controlled risk factors, or those with metabolic syndrome), it may be most effective for the LDL goal to be less than 70 mg/dL.
    • Category II, Next Highest Risk (ten-year risk 10-20%*): your LDL goal is less than 130 mg/dL. Your doctor may set your LDL goal at less than 100 mg/dl if your LDL is 100-129.
    • Category III, Moderate Risk (ten-year risk less than 10%*): your LDL goal is less than 130 mg/dL. Your doctor may set your LDL goal at less than 100 mg/dl if your LDL is 100-129.
    • Category IV, Low Risk (0-1 risk factor*): your LDL goal is less than 160 mg/dL.

    *Risk categories are based on the Framingham Heart Study to estimate 10-year risk for coronary heart disease (heart attack and coronary death). It is based on adults ages 20 and older who do not have heart disease or diabetes. The risk factors included in the Framingham calculation are age, total cholesterol, HDL cholesterol, systolic blood pressure, treatment for high blood pressure, and cigarette smoking.

    To reduce your risk for heart disease or keep it low, it is very important to:

    • Control any other risk factors you may have, such as high blood pressure and smoking.
    • Follow a low saturated fat, low refined carbohydrate eating plan
    • Maintain a desirable weight.
    • Participate in regular physical activity.
    • Begin medication therapy as directed by your doctor.

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