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Risk Category LDL Goal LDL Level at Which to Initiate Therapeutic Lifestyle Changes (TLC) LDL Level at Which to Consider Drug Therapy
CHD or CHD Risk Equivalents (10-year risk >20%) <100 mg/dL ≥100 mg/dL ≥130 mg/dL (100-129 mg/dL: drug optional)*
2+ Risk Factors (10-year risk less than or equal to20%) <130 mg/dL ≥130 mg/dL 10-year risk 10-20%: ≥130 mg/dL

10-year risk <10%: ≥160 mg/dL

0-1 Risk Factor** <160 mg/dL ≥160 mg/dL ≥190 mg/dL
(160-189 mg/L: LDL-lowering drug optional)

* Some authorities recommend use of LDL-lowering drugs in this category if an LDL cholesterol <100 mg/dL cannot be achieved by therapeutic lifestyle changes. Others prefer use of drugs that primarily modify triglycerides and HDL, e.g., nicotinic acid or fibrate. Clinical judgment also may call for deferring drug therapy in this subcategory.

** Almost all people with 0-1 risk factor have a 10-year risk <10%, thus 10-year risk assessment in people with 0-1 risk factor is not necessary.

References:

1) Grundy SM, Cleeman JI, Bairey Merz CN, et al, for the Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-239.

2) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC)