About Cholesterol Prevention Management My Health Care Team. About Cholesterol. What Your Cholesterol Levels Mean. Understand your test results. Cholesterol Illustration Library. See cholesterol illustrations. Play Video Text. Watch the video about cholesterol. How to Get Your Cholesterol Tested.

Read about this easy but important test. Cooking to Lower Cholesterol. Find simple cooking tips. Move More, Sit Less. Learn the AHA recommendations. Cholesterol Medications.

Learn about statins and other medications. My Cholesterol Guide. View the guide. How to Manage High Cholesterol Play Video Text. Watch the video to manage high cholesterol. In young adults 20 to 39 years of age, an assessment of lifetime risk facilitates the clinician—patient risk discussion and emphasizes intensive lifestyle efforts.

In all age groups, lifestyle therapy is the primary intervention for metabolic syndrome. Expert Perspective: As with generalized obesity, the lifestyle changes to eliminate one or more of the metabolic syndrome components often need a multidisciplinary effort over long periods of time to prevent recidivism.

In patients with clinical ASCVD, reduce low-density lipoprotein cholesterol LDL-C with high-intensity statins or maximally tolerated statins to decrease ASCVD risk.

Greater LDL-C reductions on statin therapy, leading to lower LDL-C levels, lower significant risk. Expert Perspective: The guideline definition of clinical ASCVD includes stroke, transient ischemic attack TIA , documented coronary artery disease CAD with stable angina, acute coronary syndromes ACS , coronary or other arterial revascularization, peripheral vascular disease with or without claudication, and aortic aneurysm.

In those who are low risk with evidence of ischemia, the addition of a coronary artery calcium CAC score would help clarify risk. Expert Perspective: Patients with HeFH are approved by the Food and Drug Administration FDA and most insurance carriers for PCSK9 inhibitor therapy regardless of presence of ASCVD because of very high risk.

HeFH is more common than previously thought and needs to be considered in all persons with premature coronary disease and those with elevated LDL-C and family members with premature CAD or high LDL-C. In adults 40 to 75 years of age evaluated for primary ASCVD prevention, have a clinician—patient risk discussion before starting statin therapy.

Risk discussion should include a review of major risk factors e. Expert Perspective: Primary care physician time constraints often necessitate use of trained nonphysician providers for risk assessment and discussions and referral to lipid or other prevention specialists, particularly for patients with a family history of premature coronary disease and major risk factors.

Risk-enhancing factors favor statin therapy see 8. If risk status is uncertain, consider using CAC to improve specificity see 9. If the CAC score is zero, treatment with statin therapy may be withheld or delayed, except in cigarette smokers, those with diabetes mellitus, and those with a strong family history of premature ASCVD.

Considering that it can be performed at less than the cost of an ECG, and that the results are highly impactful, it makes no sense that it is not paid by a third party. High CAC scores have been shown to enhance compliance with lifestyle behavior and help patients decide on a long-term treatment strategy in the absence of symptoms.

Assess adherence and percentage response to LDL-C—lowering medications and lifestyle changes with repeat lipid measurement 4 to 12 weeks after statin initiation or dose adjustment, repeated every 3 to 12 months as needed.

Define responses to lifestyle and statin therapy by percentage reductions in LDL-C levels compared with baseline.

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Show references Your guide to lowering your cholesterol with TLC. National Heart, Lung, and Blood Institute. pdf Accessed May 22, Kumar P, et al. Lipid and metabolic disorders.

In: Kumar and Clark's Clinical Medicine. Philadelphia, Pa. Accessed May 22, Tangney CC, et al. Lipid lowering with diet or dietary supplements. Catapano AL, et al. Department of Health and Human Services and U.

Department of Agriculture. Final determination regarding partially hydrogenated oils removing trans fat. Food and Drug Administration. Accessed June 28, Cooking to lower cholesterol. American Heart Association. Fekete AA, et al.

Whey protein lowers blood pressure and improves endothelial function and lipid biomarkers in adults with prehypertension and mild hypertensions: Results from the chronic Whey2Go randomized controlled trial. American Journal of Clinical Nutrition. Douglas PS.

Exercise and fitness in the prevention of atherosclerotic cardiovascular disease. Accessed May 30, Hyperlipidemia adult. Browse Topics. Topics A-Z.

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Accessed October 18, Wall HK, Ritchey MD, Gillespie C, Omura JD, Jamal A, George MG. Vital Signs : Prevalence of key cardiovascular disease risk factors for Million Hearts ® — United States, — Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from participants in 26 randomised trials.

Ganga HV, Slim HB, Thompson PD. A systematic review of statin-induced muscle problems in clinical trials. Tobert JA, Newman CB. The nocebo effect in the context of statin intolerance. J Clin Lipidol. Rosenson RS, Baker S, Banach M, Borow KM, Braun LT, Bruckert E, et al.

Optimizing cholesterol treatment in patients with muscle complaints. Food and Drug Administration. ZETIA ® ezetimibe tablets drug label. pdf [PDF — K]. Updated September National Library of Medicine.

PCSK9 gene. Genetics Home Reference. Rockville, MD: National Institutes of Health; Updated October 16, Jin J.

PCSK9 inhibitors for treating high cholesterol. Page last reviewed: March 4, Content source: Division for Heart Disease and Stroke Prevention.

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Watch the video about cholesterol. How to Get Your Cholesterol Tested. Read about this easy but important test. Cooking to Lower Cholesterol. Find simple cooking tips. Move More, Sit Less. Learn the AHA recommendations. Cholesterol Medications. Learn about statins and other medications.

My Cholesterol Guide. View the guide. How to Manage High Cholesterol Play Video Text. Watch the video to manage high cholesterol. Considering that it can be performed at less than the cost of an ECG, and that the results are highly impactful, it makes no sense that it is not paid by a third party.

High CAC scores have been shown to enhance compliance with lifestyle behavior and help patients decide on a long-term treatment strategy in the absence of symptoms. Assess adherence and percentage response to LDL-C—lowering medications and lifestyle changes with repeat lipid measurement 4 to 12 weeks after statin initiation or dose adjustment, repeated every 3 to 12 months as needed.

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JACC Quality Improvement for Institutions NCDR CardioSmart MedAxiom Accreditation Services Contact Us Heart House N St. NW Washington , DC Email: membercare acc. org Phone: Toll Free: Fax: Media Center ACC. All rights reserved. The updated guideline continues to base treatment on risk, but also recommends non-statin therapy based on cholesterol level in patients at very high risk.

The recommendation for the addition of a non-statin is based on a systematic review of the evidence, Frost said. However, she added that the other recommendations in the guideline are based solely on individual studies and expert opinion, rather than an evaluation of the totality of evidence.

For additional context, Frost pointed to the U. Preventive Services Task Force's USPSTF's recommendation statement on statin therapy for the primary prevention of cardiovascular disease, which the Academy has endorsed. A special report published as a companion to the cholesterol guideline offers a more detailed explanation of the use of quantitative risk assessment in primary prevention for cardiovascular disease.

Using population-based formulas, the guideline recommends that physicians examine "risk-enhancing factors" and discuss them with patients to personalize their risk assessment, while also continuing to use traditional risk factors such as smoking, hypertension and high blood sugar to address under- or overestimated risk in some individuals.

In primary and secondary prevention, when high cholesterol can't be controlled by diet or exercise, statins are typically used to lower LDL cholesterol levels and CVD risk.