From the Guidelines
Based on the total cholesterol level of 175 mg/dL, no cholesterol-lowering medication is needed at this time, as this level is below the threshold of 190 mg/dL for initiating treatment in asymptomatic individuals without other cardiovascular risk factors, as recommended by the European guidelines on cardiovascular disease prevention in clinical practice 1. However, a complete lipid profile would provide more comprehensive information, including LDL cholesterol, HDL cholesterol, and triglycerides, which are important for fully assessing cardiovascular risk. Lifestyle measures remain important for maintaining healthy cholesterol levels, including:
- A diet rich in fruits, vegetables, whole grains, and lean proteins, while limiting saturated fats and trans fats
- Regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise weekly
- Maintaining a healthy weight
- Avoiding tobacco
- Limiting alcohol consumption If there are other cardiovascular risk factors present, such as diabetes, hypertension, smoking, or family history of premature heart disease, a more aggressive approach to cholesterol management might be warranted despite the normal total cholesterol level, as suggested by the American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood 1 and the AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update 1. Additionally, the coronary risk evaluation in patients with transient ischemic attack and ischemic stroke guidelines recommend lipid management, with a primary goal of LDL 100 mg/dL, and emphasize the importance of lifestyle modification, including dietary changes and physical activity, as well as consideration of drug therapy if necessary 1.
From the Research
Treatment Options for Elevated Cholesterol
- For patients with mildly or moderately elevated blood pressure and blood cholesterol, lifestyle-only approaches are the first line of therapy 2.
- Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, and is a recommended lifestyle change 2.
Medication Options
- Statins are used as first-line treatments for high-risk patients with hypercholesterolemia, but statin monotherapy is often insufficient to achieve target low-density lipoprotein cholesterol (LDL-C) levels 3.
- The addition of ezetimibe to ongoing simvastatin, atorvastatin, or rosuvastatin monotherapy offers greater reduction in LDL-C among patients at high risk of cardiovascular disease (CVD) compared to doubling the initial statin dose 3, 4.
- Ezetimibe and statin combination therapy significantly decreases LDL-C, non-HDL-C, and total cholesterol levels in patients with high cardiovascular risk, with ezetimibe combined with atorvastatin having the best therapeutic effect 4.
Dietary Changes
- Dietary measures to lower levels of LDL-C and triglyceride and reduce cardiovascular (CVD) outcomes include minimizing saturated fats and refined carbohydrates, eliminating trans-fat, and increasing fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids 5.
- Adhering to a Mediterranean diet is strongly recommended because of its ability to lower CVD and total mortality 5.
Considerations for Total Cholesterol Level of 175
- Given the total cholesterol level of 175, lifestyle changes such as increasing physical activity and dietary changes may be sufficient to manage cholesterol levels 2, 5.
- If medication is necessary, statins or ezetimibe and statin combination therapy may be considered, depending on the patient's individual risk factors and medical history 3, 4, 6.