What Should My Cholesterol Goals Be?
Anyone who cares about their risk for heart disease and stroke should understand cholesterol and its role in heart health. Once you know that, then what? How does one go about setting goals to keep their cholesterol levels from putting them at risk?
Why Cholesterol Matters
Cholesterol is a soft, waxy, fat-like substance that is found in cells inside the body. It is used in the body’s synthesis of various hormones and bile acids. Because it is in every cell, your liver makes all the cholesterol you need and then circulates it through the blood. It cannot dissolve in blood, so particles known as lipoproteins help transport it from the liver to the cells via the bloodstream.
There are two types of lipoprotein. LDL cholesterol is considered the “bad” cholesterol because it contributes to fatty buildups in the arteries (atherosclerosis). Atherosclerosis narrows the arteries and increases the risk for heart attack, stroke and peripheral artery disease (PAD).
HDL cholesterol is referred to as the “good” cholesterol because experts believe that it acts as a scavenger, carrying LDL cholesterol away from the arteries and back to the liver, where it is broken down and eliminated from the body. But HDL cholesterol does not scavenge all the LDL — only one-third to one-fourth of blood cholesterol is carried away.
A healthy HDL cholesterol level may protect against heart attack and stroke. Studies show that low levels of HDL cholesterol increase the risk of heart disease.
Too much of the bad kind, or not enough of the good kind, increases the risk of cholesterol slowly building up in the inner walls of the arteries that feed the heart and brain, contributing to atherosclerosis.
Goal One: Know your risk level
Though the principle of “lower is better” is true for LDL cholesterol levels, health care providers no longer identify an ideal target for it in the general population — nor one for HDL. Instead, they consider cholesterol to be one of a combination of factors in determining a person’s long-term risk of atherosclerotic cardiovascular disease (ASCVD).
If you’re between 20 and 39, your health care provider may assess your lifetime risk. If your risk is high or if you have a family history of early CVD and have an LDL of 160 mg/dL or more, your health care provider may recommend statin medications and lifestyle changes to lower your risk.
If you’re between the ages of 40 and 75, you can use a risk calculator based on the most recent heart disease prevention guidelines to estimate your 10-year risk of having a heart attack or stroke.
Risk factors in the calculation of a person’s 10-year risk level for ASCVD include:
- Total cholesterol
- LDL cholesterol
- HDL cholesterol
- Diabetes status
- Systolic blood pressure (the top number)
The calculator also considers whether or not the person smokes, is on aspirin therapy or is taking a statin or blood pressure medication. Calculated results determine the following risk levels for the person’s next 10 years:
<5% indicates low risk.
5% to 7.5% indicates moderate risk.
7.5% to 20% indicates intermediate risk.
Above 20% is considered high risk.
Because growing older is a risk factor for CVD and is something that none of us can prevent —even when all the other factors are in check — a person’s 10-year risk will likely increase over time. All the more reason to set achievable health goals now and reduce your lifetime risk as much as possible.
Goal Two: Work with your health care provider
Once you’ve calculated your risk, print out your results page and take it with you when you meet with your doctor. They have access to a more detailed calculator, and the two of you will work together to set the right health goals for you. Based on your results, if you and your doctor are uncertain of next steps, they may also request a test to check the calcium in your blood.
Based on your risk level, your health care provider may want to discuss your taking a statin medication to lower LDL cholesterol. Unfortunately, at this time, there is no medication that can help increase your HDL.
It is important that you make an appointment with your doctor. Some factors that may impact your 10-year risk aren’t accounted for in the risk calculator. For example, the calculation might overestimate risk for people who have had regular screening and prevention. You and your health care provider can talk about factors that can increase your risk of heart disease or stroke, such as:
- Family history of premature ASCVD
- High blood pressure or high levels of LDL-cholesterol or triglycerides
- Cigarette smoking
- Metabolic syndrome
- Chronic kidney disease
- History of preeclampsia or premature menopause (for those under 40)
- Chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, or chronic HIV)
- High-risk race (e.g., South Asian)
If you have a family history of early heart disease or any of the factors above, make sure to mention it to your health care provider. They may want to learn more and may suggest medications to lower your risk.
To get started on addressing your LDL and other risks before seeing your health care provider, work toward achievable goals to:
- Eat a heart-healthy diet
- Be active — move more and sit less
- Keep your weight in check
This information is provided as a resource to our readers. The tips, products or resources listed or linked to have not been reviewed or endorsed by the American Heart Association.