From the Guidelines
A total cholesterol level of 222 mg/dL is considered borderline high and warrants attention, with the goal of lowering it to below 190 mg/dL, as recommended by the European guidelines on cardiovascular disease prevention in clinical practice 1. To achieve this, lifestyle modifications are essential, including:
- Adopting a heart-healthy diet low in saturated fats and trans fats
- Increasing physical activity to at least 150 minutes of moderate exercise per week
- Maintaining a healthy weight
- Limiting alcohol consumption
- Quitting smoking if applicable Focus on consuming more fruits, vegetables, whole grains, lean proteins, and foods rich in omega-3 fatty acids. If these changes don't sufficiently lower your cholesterol within 3-6 months, medication may be necessary, with statins like atorvastatin or rosuvastatin being the most commonly prescribed, as supported by the implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines 1. The decision to start medication depends on your overall cardiovascular risk, which includes factors like age, blood pressure, diabetes status, and family history, as emphasized in the cardiovascular health in childhood guidelines 1. Regular follow-up testing every 6-12 months is recommended to monitor your progress. It is crucial to note that cholesterol levels above 200 mg/dL increase your risk of developing atherosclerosis, where fatty deposits build up in your arteries, potentially leading to heart disease or stroke. Therefore, it is essential to work towards lowering your total cholesterol level to minimize this risk and improve your overall quality of life.
From the Research
Total Cholesterol Levels
- A total cholesterol level of 222 is considered high, as it exceeds the recommended levels for adults [ 2 ].
- High total cholesterol levels are associated with an increased risk of cardiovascular disease, including conditions such as myocardial infarction, stroke, and peripheral arterial diseases [ 2 ].
Treatment Options
- Statins and ezetimibe are commonly used to reduce plasma cholesterol levels, including total cholesterol [ 2 ].
- Combination therapy of statins and ezetimibe has been shown to be effective in reducing total cholesterol levels, with some studies suggesting it may be more effective than double-dose statin monotherapy [ 3 ].
- For patients with high cardiovascular risk, the goal is to achieve a significant reduction in total cholesterol levels, with some guidelines recommending a reduction of at least 50% [ 4 ].
Controversies and Debates
- Some studies have questioned the role of LDL-C in causing cardiovascular disease, suggesting that the relationship between cholesterol levels and cardiovascular risk is more complex [ 5 ].
- However, other studies have demonstrated the effectiveness of LDL-C-lowering therapies, including statins and ezetimibe, in reducing cardiovascular risk [ 3 , 6 ].