If you are being treated with a statin for secondary prevention then the recommended target levels are;-
All the medical trials show that people who already have a low cholesterol but still have heart attacks benefit from being on a statin.
In this case the aim is to achieve a cholesterol level at least 30% lower than it was before the heart attack.
The same targets are used for all patients who are prescribed statins for secondary prevention. This to get to a total cholesterol level of 4 mMol/L or less and an LDL level of 2 mMol/L or less or a 30% reduction from your highest levels whichever is lowest.
One point worth knowing and remembering is that interestingly, cholesterol levels fall dramatically in the hours after the onset of a heart attack and do not return to the 'normal' level for that patient for up to three months. It is therefore worth waiting until at least three m
There is excellent scientific evidence of benefit in clinical trials for all the statins listed below.
Any of these drugs can be used as long as the target cholesterol is achieved.
These drugs have different dose ranges and are listed above in an ascending order of their efficacy (ability to lower cholesterol levels for a given dose strength).
Pravastatin is the 'weakest' and Rosuvastatin the 'strongest'
Most doctors will prescribe the drugs in the following dose ranges:-
Again, however, I would stress that the right drug is the one that suits you. That is the one that achieves the target cholesterol level without giving you any side effects.
It is rarely worth increasing dose levels to higher than those above as this usually does not produce significant further reductions in cholesterol but does increase the risk of side effects
Some people have to accept lower doses of statins despite not getting to the target cholesterol levels, either because of side effects at higher doses of the drugs, or because for them the targets simply cannot be achieved.
In either case if they can take some statin then they will have lowered their future risk of cardiovascular events - principally heart attacks and strokes.
If the target cholesterol levels cannot be achieved, then other lipid lowering drugs may be useful, either alone, or in combination with statins. Amongst these you may be prescribed Ezetemibe, Fibrates or nicotinic acid derivatives.
With primary prevention there are no recommended target cholesterol levels.
As someone without any known vascular disease (but with a higher than average risk of developing problems in the future) the treatment aim is to significantly reduce the risk of you developing heart attacks and other vascular problems.
Therefore it is recommended that you should be prescribed Simvastatin 40mg daily which typically will reduce your cholestrol enough (about 30 to 40%) to lower your risk of future cardiovascular events (heart attack and strokes) by around 30%.
When someone tells you your 'Cholesterol' level this is usually the total cholesterol. Cholesterol however has several different components of different sizes. These components range from very small in size (Very Low Density Lipopropein; VLDL) to large ( High Density Lipoprotein; HDL)
The three measurements of cholesterol that we most often carry out in routine clinical practice are High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL) and Total Cholesterol (TC)
This is because whilst total cholesterol levels are related to the risk of vascular diseases it is the LDL component that is deposited in the walls of the blood vessels causing the narrowing that produces the symptoms and the heart attacks and strokes. As LDL is the largest component of the total cholesterol in most people, total cholesterol is a reasonable measure of risk if this is the only measurement available. Most modern laboratories now automatically measure HDL and LDL as well as Total Cholesterol on all their lipid tests and if these are available the complete lipid profile will give a more accurate prediction of potential for cardiovascular disease.
Whilst LDL is a relatively small molecule that is deposited in the arterial wall, HDL is a large molecule which circulates within the blood stream and to which LDL can attaches. This allows the LDL to be transported away from the sites where it might otherwise be deposited, to the liver where it can be metabolised (broken down). Therefore, the more HDL that you have, the less damage is likely to be caused to the blood vessels for any given level of LDL. An analogy might be where you can think of the LDL be the amount of rubbish that you put out in the dustbins each week and the HDL being the number of times the rubbish collected. Clearly even where you are putting out more rubbish if the dustmen come more frequently less rubbish will accumulate than where you produce less rubbish but the dustmen hardly ever call!
This is why the levels of HDL are very important and the ratio between this 'good' cholesterol and the 'bad' LDL cholesterol matters. Clearly,therefore, there will be some people with higher cholesterol levels than others but they will still be at relatively less risk because they have higher HDL levels meaning that they deposit less of their LDL cholestrol in the blood vessel walls.
No NO! NO!
Whilst statins reduce your cholesterol dramatically there are many other benefits of a healthy diet that are not related just to an improvement in the lipid levels circulating in your blood stream.
Reducing the total amount of fat in your diet will not only help improve your lipid levels but will undoubtably also reduce your calorie intake making you lighter, fitter and more able to exercise. This may make you feel better and will also have added benefits in reducing the likelihood of later developing Type 2 diabetes which is strongly related to being overweight and not taking enough exercise. Exercise also increases the amount of HDL ('good') cholesterol therefore again reducing your cardiovascular risk.
Commercially available dairy products (usually butter substitute spreads such as Flora pro active or Benecol) contain stanols and sterols which are found naturally in plants. These, when ingested in high levels, block some of the absorption of cholesterol in the gut and lead to a reduction in both total cholesterol and LDL cholesterol. They have no effect on HDL cholesterol.
The likely reduction is about 5-10% in most people which would be expected to give a health benefit, although there have been no properly conducted clinical trials to show that the improvements in lipid profiles achieved in this way have reduced cardiovascular events.
Whilst the most commonly prescribed doses of statins typically reduce the total and LDL cholesterol by 30-40% the effects of sterols and stanols should in most cases be additive to this reduction as the effect is on absorption from the gut rather than on cholesterol metabolism in the liver as with the statins.
High levels of sterols and stannols are found in extra virgin olive oil, avocado oil and wheat germ.