What is the role of CHD risk in determining the treatment of familial hypercholesterolemia (FH)?

Updated: Oct 04, 2021
  • Author: Mose July, MD, CCD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Treatment of elevated LDLc levels is based upon the risk for a coronary heart disease (CHD) event (see Table 1). The 2001 National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) defined target LDLc levels and levels based on risk for CHD. [6] The 2004 update added optional lower LDLc goals to reflect the findings of several interventional trials demonstrating that more aggressive LDLc lowering further reduced coronary event rate. [8]

Table 1. LDLc Target levels and levels Indicating Therapeutic Lifestyle Changes (TLC) and Drug Therapy (Open Table in a new window)


Risk Category


LDLc Target level,



LDLc level Indicating TLC,



LDLc level for Considering Drug Therapy,


High risk:

CHD or CHD risk equivalent

(10-y risk >20%)

< 100

Optional goal < 70



Moderately high risk:

More than 2 risk factors

(10-y risk 10-20%)


Optional goal < 100



(100-129 may consider drug options)

Moderate risk:

More than 2 risk factors

(10-y risk 10%)

< 130



Lower risk:

0-1 risk factor

< 160



(160-189 LDL-lowering drug optional)

*The 2004 update recommended that when statin therapy is initiated in patients at high or moderately high risk, a dose and strength should be chosen that achieves at least a 30-40% LDLc reduction (see Table 3).

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