How Cholesterol Factors into Heart Disease Risk

Managing cholesterol is an important part of staying heart healthy. When it comes to understanding the new cholesterol guidelines, experts say there are a few things to keep in mind:

In general, the higher your low-density lipoprotein (LDL) cholesterol, the more likely you are to develop heart disease or have a heart attack or stroke. 

That’s why high LDL or total cholesterol levels should ideally trigger a conversation between you and your clinician about your personal risk, or chance, of developing cardiovascular disease (CVD). Similarly, you should review other factors — in addition to cholesterol — that raise your risk of a heart attack or stroke; for example, high blood pressure, diabetes, smoking, family history of heart attack or stroke.

And this shouldn’t be a one-time conversation because the risk for heart disease and treatments change over time. Your cholesterol levels should also be re-checked on occasion to see if your treatment is working. 

What is ASCVD?

Heart attack and stroke are usually caused by atherosclerotic cardiovascular disease (ASCVD). ASCVD develops because of a buildup of sticky cholesterol-rich plaque. Over time, this plaque can harden and narrow the arteries.

Adopting a healthy lifestyle — exercising, heart-healthy eating, maintaining a healthy body weight and not smoking — is essential, regardless of your cholesterol level or risk for heart disease. 

Making healthy choices every day can help to:

  • Prevent, as well as treat, high cholesterol and
  • Lower your risk of heart disease or having a heart attack or stroke

A healthy lifestyle will also help you feel better overall. 

Some people will also need a cholesterol-lowering medication, starting with a statin. 

Statins are the go-to medication for lowering LDL cholesterol. Studies show they can also:

  • Protect against the stiffening or hardening of the arteries (called atherosclerosis)
  • Help prevent heart attacks and strokes
  • Help save lives

Non-statin therapies should be discussed and considered when:

  • A statin by itself doesn’t sufficiently lower your LDL cholesterol or risk of a heart attack or stroke based on your and your clinician's goals or expectations.
  • If you can’t take a statin for some reason (or can’t tolerate the dose of statin recommended for you due to side effects), despite you and your clinician taking measures to get you on the right statin (there are many) or manage side effects.

Heart healthy life habits + cholesterol-lowering medications = best chance of preventing a heart attack or stroke for people who also need medication

There’s no one-size-fits-all approach to managing cholesterol. 

That’s why the updated guidelines have been expanded to give clinicians the tools to tailor cholesterol treatments and be able to assess cardiovascular risk in many different types of patients. For example, people:

  • At different stages of life — children, adults and older adults
  • Of different racial and ethnic backgrounds, and genders 
  • With other health conditions that need to be factored in

In addition, they are designed to offer guidance on preventing:

  • A first heart attack or stroke (primary prevention)
  • Another heart attack, stroke or worsening heart disease (secondary prevention)

Cholesterol is only one piece of the puzzle.  

Be aware of other conditions that increase your chances of having a heart problems. Cholesterol is only one risk factor for heart disease and stroke. Other things that increase your risk may also need to be addressed. For example:

  • High blood pressure
  • Preventing or treating diabetes
  • Preventing or treating obesity
  • Stopping smoking
  • Incorporating lifestyle changes more consistently — eating heart healthy and being more active

Be sure to talk with your clinician about other health issues that worry you. 

What You Can Do

  • Ask about your 10-year risk score if you don’t already have heart disease
  • Talk about other factors that might increase your risk (called “risk enhancers”)
  • If there’s any doubt, ask if CAC scoring could help 
  • Have ongoing discussions about your risk for heart disease, heart attack or stroke keeping in mind risk and available therapies change over time
  • If you are prescribed medication(s), take it as directed, and share any concerns before stopping.
  • Stick to a heart-healthy lifestyle. Enlist your family and others to help support you.
Talking About Your Cholesterol Levels >

High Cholesterol Home

Published: November 2018
Medical Reviewers: Martha Gulati, MD, MS, FACC, FAHA, FASPC; Salim S. Virani, MD, FACC

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