From the Guidelines
An LDL cholesterol level of 143 mg/dL is considered high and requires immediate attention to reduce cardiovascular risk, with a goal to lower it below 100 mg/dL, as recommended by the National Cholesterol Education Program Adult Treatment Panel III guidelines 1. To manage this level, several steps can be taken:
- Lifestyle modifications are the first line of treatment, including adopting a heart-healthy diet low in saturated fats and trans fats, and high in fruits, vegetables, whole grains, and lean proteins.
- Regular exercise of at least 150 minutes of moderate activity per week is recommended, as it can help lower LDL cholesterol levels and improve overall cardiovascular health.
- Weight loss of 5-10% of body weight can significantly improve cholesterol levels if you're overweight, as it reduces the body's cholesterol production and increases the clearance of LDL cholesterol from the bloodstream.
- If these measures don't sufficiently lower your LDL within 3-6 months, medication may be necessary, with statins like atorvastatin (10-80 mg daily) or rosuvastatin (5-40 mg daily) being typically the first-line treatment, as they have been shown to effectively reduce LDL cholesterol levels and decrease the risk of major coronary events 1. It's essential to work closely with your healthcare provider to monitor your progress and adjust treatment as needed, ensuring that your LDL cholesterol level is managed effectively to reduce your risk of cardiovascular disease.
From the FDA Drug Label
Table 12: Lipid-altering Effects of Atorvastatin Calcium in Adolescent Males and Females with Heterozygous Familial Hypercholesterolemia or Severe Hypercholesterolemia (Mean Percentage Change From Baseline at Endpoint in Intention-to-Treat Population)
DOSAGENTotal-CLDL-CHDL-CTGApolipoprotein B Placebo47-1.5-0.4-1.91.00.7 Atorvastatin Calcium Tablets140-31.4-39.62.8-12.0-34. 0
The LDL-C reduction with atorvastatin was -39.6%. To determine the expected LDL-C level after treatment with atorvastatin, we can calculate:
- Initial LDL-C level: 143 mg/dL
- Expected reduction: 39.6%
- Expected LDL-C level after treatment: 143 mg/dL * (1 - 0.396) = 143 mg/dL * 0.604 = 86.4 mg/dL 2
From the Research
LDL Cholesterol Levels
- An LDL cholesterol level of 143 is considered elevated, which is a major cardiovascular risk factor 3.
- Elevated low-density lipoprotein cholesterol (LDL-C) is a principally modifiable cause of atherosclerotic cardiovascular disease 4.
Treatment Options
- Statins are the first-line therapy for reducing LDL cholesterol levels and preventing atherosclerotic cardiovascular disease (ASCVD) 3, 5.
- Ezetimibe, a cholesterol absorption inhibitor, can be used in combination with statins to further reduce LDL cholesterol levels and decrease ASCVD risk 3, 6.
- Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, such as alirocumab and evolocumab, can be used to lower LDL cholesterol levels in patients who are not achieving treatment goals with statins and ezetimibe 3, 5, 6.
Target LDL Cholesterol Levels
- The European guidelines recommend lowering LDL-C to <1.4 mmol/L (<55 mg/dL) in patients with very high-risk cardiovascular disease 4.
- The use of PCSK9 inhibitors can help achieve these target levels in patients who are not able to achieve them with conventional agents 4, 5.
Special Considerations
- In patients with chronic kidney disease (CKD), LDL cholesterol reduction is important to prevent atherosclerotic cardiovascular disease (ASCVD) events 7.
- PCSK9 targeting therapies, including monoclonal antibodies and the PCSK9 synthesis inhibitor inclisiran, may be useful in high-risk CKD patients, including those with prior ASCVD 7.