Cholesterol numbers are still important — but they're no longer the only factor used to determine your risk for heart disease or whether cholesterol-lowering medication may be recommended.
For many years, the primary goal of cholesterol treatment was to lower LDL ("bad cholesterol") levels to less than 100mg/dL, or even lower for certain patients. While LDL remains an important measure, guidelines from the American Heart Association and the American College of Cardiology take a more comprehensive approach to heart health by focusing on a person's overall risk for heart attack and stroke.
Rather than relying on a single number, today's approach looks at the bigger picture.
How Heart Disease Risk is Assessed Today
Heart disease risk is now evaluated using a combination of factors that influence cardiovascular health over time. These include:
- Age and sex
- Body mass index (BMI)
- Family history of heart disease
- Total cholesterol, LDL, and HDL levels
- Blood pressure
- Diabetes and fasting blood sugar levels
- Smoking status
Thees factors are entered into a risk calculator to estimate a person's chance of developing heart disease within the next 10 years. Individuals with a 10-year risk score of 7.5% or higher are generally considered at increased risk and may benefit from cholesterol-lowing medication as part of their treatment plan.
While some critics believe this calculator may identify more people as “at risk” than in the past, the intent is to encourage earlier intervention and healthier lifestyle choices — both of which can significantly reduce long-term cardiovascular risk.
Although not the same risk calculator that was used in developing the new guidelines, the American Heart Association offers a good online risk calculator. To calculate your 10-year risk, visit heart.org/ and search for “Heart Attack Risk Assessment.”
When Cholesterol-Lowering Medications are Recommended
When a person's overall risk for heart disease is elevated, medication may be recommended alongside lifestyle changes. Guidelines for these medications have also evolved.
Non-statin cholesterol-lowering drugs are no longer routinely recommended, as research has not shown consistent improvement in long-term cardiovascular outcomes.
Statin medications, however, remain the standard treatment for many patients and are typically recommended for individuals who fall into one of the following categories:
- Adults between ages 40 and 75 with a calculated 10-year heart disease risk of 7.5% or higher
- Adults ages 40 to 75 with diabetes
- Individuals with diagnosed heart disease
- Individuals with LDL cholesterol levels of 190mg/dL or higher
If you are currently taking cholesterol-lowering medication, it's important to talk with your provider about how these guidelines apply to you and what steps can best reduce your risk of heart attack or stroke.
Seven Ways to Reduce Your Risk of Heart Disease
While some risk factors — such as age and genetics — can't be changed, many others are within your control. Taking proactive steps can significantly improve heart health for both men and women:
- Eat a diet that's rich in fresh fruits and vegetables; low in saturated fat, trans fats, and cholesterol; and high in fiber. Limit salt and sodium.
- Maintain a healthy weight. The Centers for Disease Control and Prevention offers body mass index (BMI) calculators for both adults and children.
- Exercise to build heart muscle, lose or maintain weight, and lower cholesterol and blood pressure.
- Know your numbers. Have your blood pressure and cholesterol checked regularly. If you have diabetes, closely monitor your blood sugar levels and get an A1C test about every 3 months.
- Don't smoke. One year after quitting, your risk of heart disease is cut in half. After 15 years, your risk is nearly the same as in someone who has never smoked.
- Limit alcohol use. Do not drink to excess.
- Take your medicine. Follow your doctor's orders and don't skip doses.
Heart Disease Can Happen to Anyone
Heart disease doesn't always look the same — and it doesn't only affect people with obvious risk factors.
Even individuals who are active, eat well, and have no family history of heart disease can develop serious cardiovascular conditions. Subtle symptoms such as unexplained fatigue, reduced exercise tolerance, or chest discomfort — especially during physical activity — should never be ignored.
Listening to your body and speaking up when something feels off can be lifesaving. Early evaluation and testing can detect heart disease before a major event occurs and allow for timely treatment.
If you have concerns about your cholesterol, heart disease risk, or symptoms that don't feel normal for you, start with your primary care provider or a cardiology specialist. Together, you can develop a personalized plan focused on prevention, early detection, and long-term heart health.