From the Guidelines
An LDL cholesterol level of 137 mg/dL is considered borderline high and should be addressed to reduce your cardiovascular risk, with a goal to lower it to below 100 mg/dL, according to the ATP III guidelines 1. To achieve this goal, the following steps can be taken:
- Start with lifestyle modifications including adopting a heart-healthy diet low in saturated fats and trans fats, increasing consumption of fruits, vegetables, whole grains, and lean proteins.
- Regular exercise of at least 150 minutes of moderate activity per week is recommended.
- Weight loss of 5-10% of body weight can significantly improve cholesterol levels if you're overweight. If these measures don't sufficiently lower your LDL within 3-6 months, medication may be necessary. The ATP III guidelines suggest that for individuals with multiple (2+) risk factors, the LDL-C goal is <130 mg/dL, and for those with a 10-year risk >20%, the LDL-C goal is <100 mg/dL 1. Statins like atorvastatin (10-80 mg daily) or rosuvastatin (5-40 mg daily) are typically the first-line treatment, as they work by reducing cholesterol production in your liver and are generally well-tolerated 1. Regular follow-up cholesterol testing every 3-6 months is important to monitor your progress and adjust treatment as needed. It's essential to consider the individual's risk factors, such as existing heart disease or diabetes, when determining the best course of treatment, as these factors can impact the LDL-C goal and treatment approach 1.
From the FDA Drug Label
The mean achieved LDL-C value was 130.7 mg/dL (range: 70 to 242 mg/dL) in the atorvastatin calcium group compared to 228.5 mg/dL (range: 152 to 385 mg/dL) in the placebo group during the 26-week double-blind phase. The starting atorvastatin dosage was 10 mg once daily and doses were adjusted to achieve a target of <130 mg/dL LDL-C
An LDL level of 137 is slightly above the target of <130 mg/dL. 2
From the Research
Significance of LDL Level 137
- An LDL level of 137 is considered elevated, as the general guideline is to strive for an LDL cholesterol level of < 55 mg/dl (< 1.4 mmol/l) in patients with a very high risk, such as those with established atherosclerotic disease 3.
- The treatment of elevated plasma lipid levels, including LDL, plays an important role in the prevention of atherosclerosis, and lowering LDL cholesterol with statins and other medications is crucial 3, 4.
- The overall (absolute) cardiovascular risk determines the intensity of lipid-lowering treatment, and an LDL level of 137 may require treatment, especially if the patient has other risk factors 3, 5.
- Studies have shown that LDL-C lowering interventions, including statins, ezetimibe, and PCSK9 inhibitors, can reduce the risk of cardiovascular events, and the percentage LDL-C reduction with these therapies is not attenuated in patients starting with lower baseline LDL-C levels 6, 7.
- In fact, one study found that the percentage LDL-C reduction with evolocumab, a PCSK9 inhibitor, was higher in patients with lower baseline LDL-C levels, ranging from 59.4% to 66.1% 7.
- Therefore, an LDL level of 137 may be a target for treatment, especially if the patient has other risk factors or is not responding to lifestyle modifications, and the goal of treatment would be to reduce the LDL level to < 55 mg/dl (< 1.4 mmol/l) or by at least 50% from baseline 3, 5.
Treatment Options
- Statins are the cornerstone of LDL-C lowering therapy and have consistently been shown to decrease both LDL-C and cardiovascular disease risk 3, 4, 5, 6.
- Ezetimibe and PCSK9 inhibitors can be added to statin therapy to further reduce LDL-C levels, especially in patients who do not reach the LDL-C target with statins alone 3, 4, 6, 7.
- Lifestyle modifications, such as diet and exercise, can also play a role in reducing LDL-C levels, but may not be enough to achieve the desired level of reduction, especially in patients with high cardiovascular risk 3, 5.