How is treatment determined?
Treatment is based on the overall risk of coronary heart disease. It is important that all modifiable risk factors which are present are treated. Lipid lowering treatment is only one part of the strategy for reducing coronary risk. Lipid lowering treatment is aimed foremost at lowering the LDL cholesterol level the target value being less than 2.0 mmol/L. The relative importance of achieving this target depends on the risk factors which are present. If you have heart disease or have had a stroke you are at the higher risk end of the spectrum and it is more important to achieve this target. This is what is called ‘secondary prevention’. In secondary prevention you will usually be started on cholesterol lowering treatment even if the LDL cholesterol level is already below the target. Likewise if you have diabetes, you will be commenced on cholesterol lowering treatment even if the LDL cholesterol level is already less than 2.0mmol/L. If you do not have vascular disease or diabetes and are being treated because other risk factors are present this is what is called ‘primary prevention’. In this case it may be reasonable to aim for a target LDL-cholesterol level of below 3.0mmol/L but ideally an LDL-cholesterol level of below 2.0mmol/L should be achieved in everyone. The lower the LDL-cholesterol level, the lower is the risk of coronary heart disease.
The first step in treating high LDL is targeted at changes in lifestyle – specifically adopting a diet low in saturated fat (the fat in dairy produce and meat) and participating in moderate exercise. You may be referred to a dietician for advice in making dietary changes.
If low-fat diets and exercise are not effective in lowering LDL-cholesterol to the target value, drug therapy would be the next step. There are several classes of drugs that are effective in lowering LDL cholesterol. Your LDL cholesterol will be checked at regular intervals to check that the drug is working. If the drug does not result in reaching your target LDL-cholesterol, your doctor may increase the amount of drug or possibly add a second drug.