Aim for the Right Cholesterol Target

Your doctor wants you to work on getting your LDL (“bad”) cholesterol under 130 mg/dL. But your next-door neighbor’s doctor told him to aim for less than 100 mg/dL. Which goal is correct?

“Both may be,” says Marc Kapner, M.D., a cardiologist at Montefiore Medical Center in Bronx, N.Y. The primary goal of cholesterol treatment is lowering LDL enough to reduce the risk of having a heart attack. But Dr. Kapner says that different people should aim for different LDL targets, depending on their medical history and personal risk for heart disease.

Sure, it would be nice if both you and your neighbor got your LDL below 100 mg/dL. But some people can hit that mark only with the help of medication. If your risk of having a heart attack is moderate, the benefit of taking medication to drop your LDL another 30 points may not be worth the chance of side effects. In contrast, if your neighbor’s heart attack risk is high, it could be a smart tradeoff for him. “It’s about balancing risks vs. benefits,” Dr. Kapner says.

How low should you go with your own cholesterol? Below are some general guidelines. But it’s important to talk with your doctor about working toward the right LDL goal for you.

Reaching Your LDL Goal

Your Risk Category

Your LDL Goal

(in mg/dL—milligrams per deciliter)

What You Should Do

Lower risk

One or no heart disease risk factors:

Cigarette smoking
High blood pressure
Low HDL, or “good,” cholesterol
Your age—45 and up for men, or 55 and up for women
Family history of early heart disease—before age 55 in your father or brother, or before age 65 in your mother or sister

Less than 160

If your LDL is already below 160: Adopt a heart-smart lifestyle:

Eat a healthy diet.
Exercise regularly.
Lose weight, if you’re overweight.
Quit smoking, if you’re a smoker.

If your LDL is 160 or above: Add therapeutic diet changes:

Consume less than 7% of daily calories from saturated fat.
Consume less than 200 mg of dietary cholesterol per day.
Focus on whole grains, fruits, vegetables, legumes, and fish.
Limit sodium (salt) and alcohol.

If you’ve followed these steps for three months and your LDL is still above your goal: Consider medication as well.

Moderate to moderately high risk

Two or more heart disease risk factors

and
20% or less chance of having a heart attack within the next 10 years (assess your risk with the American Heart Association

Less than 130

If your LDL is already below 130: Adopt a heart-smart lifestyle.

If your LDL is 130 or above: Add therapeutic diet changes.

If you’ve followed these steps for three months and your LDL is still above your goal: Consider medication as well.

High risk

Heart disease or diabetes

or
Greater than 20% risk of having a heart attack within the next 10 years

Less than 100

If your LDL is already below 100: Adopt a heart-smart lifestyle, and add therapeutic diet changes.

If your LDL is 100 or above: Take any prescribed medication as well.

Very high risk

Multiple or severe risk factors, such as:

A recent heart attack
Heart disease and diabetes
Heart disease and continued smoking
Heart disease, low HDL, and high triglycerides

Less than 70, if your doctor thinks this lower goal is appropriate for you

For everyone with this goal: Adopt a heart-smart lifestyle, and add therapeutic diet changes. Take any prescribed medication as well.

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