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Health: Cholestrol - How Low Can You Go?
  By Apurv Gupta, MD   

It could be the refrain in a song that is playing while you dance underneath the limbo stick. Of late it has been the mantra that doctors are chanting in reference to managing their patients’ cholesterol levels. The National Cholesterol Education Panel (NCEP)/ Adult Treatment Panel (ATP) III updated their Guidelines in 2004 making the target cholesterol very low, particularly in patients who have other risk factors for developing atherosclerosis (hardening of the arteries). 

There are risk factors that you cannot do anything about: 
  • Family History of Heart Disease at a Young Age
  • Male Gender
  • Age (greater than 45 for males; greater than 55 for females)

A few risk factors that can be modified, with some work

  • Cigarette Smoking
  • Diabetes
  • High Blood Pressure (greater than 140/90)
  • Low HDL (less than 40 mg/dL)

If you have diabetes or have known atherosclerotic disease (i.e., coronary heart disease, peripheral arterial disease, or stroke), then you are at “high risk”:

  • LDL target < 100 mg/dL
  •   * Optional target < 70 mg/dL - encouraged if “very high risk”

If you have 2 or more risk factors, you are at “moderate risk”:

  • LDL target < 130 mg/dL

If you have 0 or 1 risk factor, then you are at relatively “lower risk”:

  • LDL target < 160 mg/dL

Lifestyle changes are recommended for all patients with LDL cholesterol above target levels. These include:

  • Reduced intake of saturated fats (< 7% total calories)
  • Reduced intake of cholesterol (< 200 mg/day)
  • Weight reduction
  • Increased physical activity

Medications should be considered if:

  • Failure to achieve target LDL cholesterol levels after 12 weeks of therapeutic lifestyle changes
  • LDL cholesterol level > 30 mg/dL above target

(Please consult with your physician before implementing any treatment plan.)

(Dr. Apurv Gupta is Board Certified in Internal Medicine. He did M.D. & Sc.B. from Brown University, and Masters in Public Health from Harvard University School of Public Health. He is the President-Elect of Indian Medical Association of New England (IMANE). )

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