When should you start treatment for high cholesterol?
Aug 16, 2022
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- The decision to start a medication depends on a person’s overall risk of heart disease and stroke (cardiovascular disease)- it’s different for different people.
- A cardiovascular risk calculator can be used to figure out your risk of getting a heart attack or stroke in the next 10 years, based on your cholesterol results and other risk factors- this can help your doctor to decide if you’re low, moderate or high risk.:
- Low risk: If risk is low (less than 10% risk of heart attack or stroke in the next 10 years), then it’s reasonable to try lifestyle changes (see below) and retest in 5 years
- Moderate risk: If risk is moderate (10-15% risk of heart attack or stroke in the next 10 years), then lifestyle changes can be tried at first- if there is no significant improvement in cholesterol levels after 6 months of healthy lifestyle changes, medication may be considered. However, a decision may be made to go straight for medication if a person is in a high-risk group- for example if they are of South Asian, Pacific Islander, Maori, Middle Eastern, Aboriginal or Torres Strait Islander descent, or if they’ve a strong family history of heart attack or stroke in younger people. Lipids (cholesterol) blood tests should be repeated every 2 years in this group.
- High risk: If risk is high (over 15% risk of heart attack or stroke in the next 10 years), then both lifestyle changes AND medication should be considered. A lipid profile (cholesterol) blood test should be repeated every year.
- However, it’s important to note that some people are “high risk” purely because they have certain health issues, and may be advised to start cholesterol-lowering medication on this basis- for example if they have significant chronic kidney disease, complications from diabetes, high blood pressure (above 180mmHg systolic), familial hypercholesterolaemia, or total cholesterol above 7.5mmol.
