Treatment

The main goal in lowering LDL cholesterol is to lower the chance of a first or future heart attack or stroke due to blockages in your arteries. (Preventing a first event is called primary prevention. Preventing another one after you've survived one is called secondary prevention.)

In most cases, for primary prevention, your care team will want you to focus on making lifestyle changes first. That’s because the choices we make every day can affect our cholesterol. Here are four things that can make a difference:

1. Follow a heart-healthy plan such as the Mediterranean or DASH diets (these are less “diets” than ways to eat healthy)
2. Getting regular physical activity, and remember even 10-minute bursts of activity count 
3. Stay at a healthy weight and lose any extra pounds
4. Don’t smoke, and stay away from secondhand smoke 

If after a period of time, your LDL cholesterol is still elevated, even a little, you may need to add a statin. This is the first go-to cholesterol lowering medicine that also reduces the risk of heart attack and stroke.

All adults with FH whose LDL-C is 160 or higher or with a strong family history of premature ASCVD, a high 30-year risk, or with elevated CAC should be on a statin to prevent a first heart attack or stroke.

Your treatment plan will depend on your cholesterol levels, as well as your estimated risk of a heart attack or stroke. 

And new guidance is that treating higher levels of cholesterol earlier (to limit them circulating in the body) and getting to lower target goals for longer is best to protect heart and blood vessel health and guard against heart attack and stroke over the short and long-term.