LDL Cholesterol of 145 mg/dL: Risk Assessment
An LDL cholesterol of 145 mg/dL is considered borderline high to high depending on your cardiovascular risk profile, and warrants treatment with lifestyle modifications at minimum, with statin therapy strongly recommended if you have diabetes, established cardiovascular disease, or other significant risk factors. 1, 2
Understanding Your LDL Level
Your LDL of 145 mg/dL falls into the "borderline high" category according to current classification systems 3:
- Borderline high: 125-149 mg/dL
- High: 150-174 mg/dL
- Very high: ≥175 mg/dL
Treatment Depends on Your Risk Category
High-Risk Patients (Target LDL <100 mg/dL)
You need aggressive treatment if you have any of the following 1, 2:
- Established cardiovascular disease (prior heart attack, stroke, peripheral artery disease)
- Diabetes with additional risk factors
- 10-year cardiovascular risk ≥20%
At 145 mg/dL, you are 45 mg/dL above goal and should start high-intensity statin therapy immediately along with lifestyle changes 2. The American Heart Association recommends initiating pharmacological therapy at the same time as behavioral interventions when LDL exceeds the goal by >25 mg/dL in high-risk patients 3.
Very High-Risk Patients (Target LDL <70 mg/dL)
If you have recent acute coronary syndrome, diabetes with overt cardiovascular disease, or post-stroke status, your target is even lower at <70 mg/dL 1. At 145 mg/dL, you are 75 mg/dL above goal and require immediate high-intensity statin therapy, potentially with ezetimibe added if statin alone is insufficient 1, 2.
Moderately High-Risk Patients (Target LDL <130 mg/dL)
If you have ≥2 cardiovascular risk factors (hypertension, smoking, family history of premature heart disease, age >45 for men or >55 for women, low HDL <40 mg/dL) and 10-year risk of 10-20%, your primary goal is <130 mg/dL with an optional goal of <100 mg/dL 3, 2.
At 145 mg/dL, you are 15 mg/dL above the primary goal. Start with therapeutic lifestyle changes for 3-6 months, then add statin therapy if LDL remains elevated 3, 2.
Lower-Risk Patients (Target LDL <160 mg/dL)
If you have 0-1 risk factors, your target is <160 mg/dL 1, 2. At 145 mg/dL, you are below this threshold but should still implement lifestyle modifications to prevent progression 2.
Critical Risk Factors to Count
When determining your risk category, count these factors 3:
- Cigarette smoking
- Hypertension (blood pressure ≥140/90 or on medication)
- Low HDL cholesterol (<40 mg/dL; note that HDL ≥60 mg/dL counts as a "negative" risk factor)
- Family history of premature heart disease (male first-degree relative <55 years or female <65 years)
- Age (>45 years for men, >55 years for women)
Important caveat: Diabetes is now considered equivalent to established cardiovascular disease, not counted as a single risk factor 3.
Immediate Action Steps
Therapeutic Lifestyle Changes (Start Immediately) 2
- Limit saturated fat to <7% of total calories
- Restrict dietary cholesterol to <200 mg/day
- Eliminate trans fats completely
- Increase soluble fiber to 10-25 g/day (reduces LDL by 5-10%)
- Engage in regular aerobic exercise
- Achieve modest weight loss if overweight
Pharmacological Therapy 2
For high-risk patients, initiate high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) to achieve at least 30-40% LDL reduction 2. This would bring your LDL from 145 mg/dL down to approximately 87-102 mg/dL, meeting most treatment goals.
Special Considerations
Post-hoc analysis from the KDOQI guidelines suggests that patients with baseline LDL ≥145 mg/dL derive significant cardiovascular benefit from statin therapy, with fatal and nonfatal cardiac events significantly reduced in this subgroup 3. This reinforces that your level warrants serious attention.
The "lower is better" paradigm: Recent evidence supports that there is no lower limit beneath which LDL reduction fails to provide benefit 3, 4. Even achieving LDL <70 mg/dL or <55 mg/dL in very high-risk patients continues to reduce cardiovascular events without safety concerns 4.
Monitoring
Recheck your lipid panel 4-6 weeks after starting or adjusting therapy, then every 2-3 months until goal is achieved 1, 2. Once stable, annual monitoring is appropriate for most patients 3, 1.