From the Guidelines
An LDL cholesterol level of 100 mg/dL is generally considered good and within the optimal range for most adults, but for those with existing heart disease, diabetes, or multiple cardiovascular risk factors, a target below 70 mg/dL may be recommended. For healthy individuals without cardiovascular disease or major risk factors, an LDL below 100 mg/dL is typically the target recommended by healthcare professionals 1. However, if you have existing heart disease, diabetes, or multiple cardiovascular risk factors, your doctor might recommend an even lower target, possibly below 70 mg/dL 1. No specific medication is needed if your LDL is at 100 mg/dL unless you have these additional risk factors. Maintaining this level through a heart-healthy diet (rich in fruits, vegetables, whole grains, and lean proteins while limiting saturated fats and trans fats), regular physical activity (at least 150 minutes of moderate exercise weekly), and avoiding smoking is recommended 1. Some key points to consider include:
- Therapeutic lifestyle changes (TLC) remain an essential modality in clinical management for persons at risk for cardiovascular disease (CVD) 1.
- For high-risk persons, the recommended LDL-C goal is <100 mg/dL, but when risk is very high, an LDL-C goal of <70 mg/dL is a therapeutic option 1.
- Any person at high risk or moderately high risk who has lifestyle-related risk factors is a candidate for TLC to modify these risk factors regardless of LDL-C level 1.
- When LDL-lowering drug therapy is employed, it is advised that intensity of therapy be sufficient to achieve at least a 30% to 40% reduction in LDL-C levels 1. LDL cholesterol is often called "bad" cholesterol because elevated levels can lead to plaque buildup in your arteries, increasing your risk of heart disease and stroke 1. The body needs some cholesterol for building cells, but too much can be harmful, which is why keeping LDL at appropriate levels is important for cardiovascular health.
From the FDA Drug Label
At baseline: 3,421 patients (17%) had LDL-C levels below 100 mg/dL, including 953 (5%) below 80 mg/dL; and 10,047 patients (49%) had levels greater than 130 mg/dL. The FDA drug label does not answer the question.
From the Research
LDL Cholesterol Levels and Cardiovascular Risk
- An LDL cholesterol level of 100 mg/dL is considered elevated and a major cardiovascular risk factor 2, 3, 4.
- The American Journal of Cardiology suggests that physiologically normal levels of LDL-C are in the 30- to 70-mg/dL range, and that atherosclerosis progression is halted and coronary heart disease events are minimized when statin therapy is used to drive down LDL-C to a range of about 30 to 50 mg/dL 4.
Treatment Options for Elevated LDL Cholesterol
- Statins are the mainstay of treatment for LDL-C lowering, but may not be sufficient in decreasing LDL cholesterol levels and pose a significant on-treatment residual risk of major cardiovascular events 2, 3.
- Ezetimibe, a cholesterol absorption inhibitor, can lead to additional LDL-C reduction and decreased ASCVD risk when added to statin therapy 2, 3, 5.
- Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, such as alirocumab and evolocumab, can significantly decrease serum LDL-C levels and ASCVD risks when added to maximally tolerated statin therapy 2, 3, 5.
LDL Cholesterol Reduction Targets
- International guidelines recommend aggressive lipid-lowering therapy in patients with atherosclerotic cardiovascular disease (ASCVD), targeting an LDL-C level of < 55 mg/dL and a ≥ 50% reduction from baseline 6.
- A study found that only 15.9% of post-acute coronary syndrome patients achieved an LDL-C level of < 55 mg/dL at 6 months, highlighting the need for structured follow-up and treatment intensification 6.