Is an LDL (Low-Density Lipoprotein) level of 140 mg/dL considered high risk?

From the Guidelines

An LDL level of 140 mg/dL is considered borderline high to high, but not necessarily high risk on its own, and according to the most recent guidelines, optimal LDL levels are below 100 mg/dL, with levels between 130-159 mg/dL classified as borderline high 1.

Key Points to Consider:

• Your overall cardiovascular risk depends on multiple factors beyond just LDL, including age, blood pressure, smoking status, diabetes, and family history.
• If you have this LDL level, you should consult with your healthcare provider who may recommend lifestyle modifications such as:
  • Adopting a heart-healthy diet low in saturated fats
  • Regular exercise (aim for 150 minutes of moderate activity weekly)
  • Weight management
  • Smoking cessation if applicable
• For some individuals, especially those with additional risk factors, medication therapy with statins like atorvastatin or rosuvastatin might be recommended.
• LDL cholesterol is considered harmful because it can build up in artery walls, forming plaques that narrow blood vessels and increase risk for heart attacks and strokes, which is why maintaining healthy levels is important for cardiovascular health.

Recommendations:

• The American Heart Association and American College of Cardiology Foundation recommend that patients with coronary and other atherosclerotic vascular disease should have a lipid profile established and lipid-lowering therapy initiated before discharge 1.
• The goal of lipid management is to achieve an LDL-C of < 100 mg/dL, and for very high-risk patients, an LDL-C < 70 mg/dL is reasonable 1.
• Lifestyle modifications, including daily physical activity and weight management, are strongly recommended for all patients 1.
• Dietary therapy should include reduced intake of saturated fats, trans fatty acids, and cholesterol 1.
• Statin therapy should be prescribed in the absence of contraindications or documented adverse effects, and an adequate dose of statin should be used to reduce LDL-C to < 100 mg/dL and achieve at least a 30% lowering of LDL-C 1.

From the Research

LDL Cholesterol Levels and Risk Assessment

• An LDL level of 140 mg/dL is considered high risk, as elevated LDL cholesterol is a major risk factor for atherosclerotic cardiovascular disease (ASCVD) 2.
• The 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines recommend LDL-C targets of less than 55 mg/dL or even less than 40 mg/dL for very high CV risk patients 3.
• Studies have shown that the risk of myocardial infarction and atherosclerotic cardiovascular disease is increased with higher LDL cholesterol levels, even in individuals aged 70-100 years 4.
• The percentage LDL-C reduction with statins, ezetimibe, and PCSK9 inhibition is not attenuated in patients starting with lower baseline LDL-C levels, and is even greater for PCSK9 inhibition 5.

Treatment and Management

• Aggressive treatment of elevated LDL-C in patients at high risk can prevent cardiac events with excellent cost effectiveness 2.
• The use of PCSK9 inhibitors, such as evolocumab and alirocumab, can reduce LDL-C by 50-60% above that achieved by statin therapy alone, and may reduce cardiovascular events and all-cause mortality in patients with clinical ASCVD 6.
• Statins and ezetimibe are also effective in reducing LDL-C levels, although the percentage reduction may vary depending on the baseline LDL-C level 5.

Risk Stratification

• Patient stratification based on the presence or absence of atherothrombotic risk factors may represent a valuable tool to identify patients at extremely high CV risk who may benefit more from an aggressive LDL-C-lowering approach 3.
• Individuals aged 70-100 years with elevated LDL cholesterol have the highest absolute risk of myocardial infarction and atherosclerotic cardiovascular disease, and may benefit from moderate-intensity statin therapy 4.