What are the cholesterol targets in hypertension (high blood pressure)?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
  • Print
Answer

The top 10 key recommendations from the AHA, ACC, and multiple other medical societies for reducing the risk of ASCVD through cholesterol management are summarized below. [73, 74]

  • Emphasize a heart-healthy lifestyle across the life course of all individuals.
  • In patients with clinical ASCVD, reduce low-density lipoprotein cholesterol (LDL-C) levels with high-intensity statin therapy or the maximally tolerated statin therapy.
  • In individuals with very high-risk ASCVD, use an LDL-C threshold of 70 mg/dL (1.8 mmol/L) to consider the addition of nonstatins to statin therapy.
  • In patients with severe primary hypercholesterolemia (LDL-C level ≥190 mg/dL [≥4.9 mmol/L]), without calculating the 10-year ASCVD risk, begin high-intensity statin therapy.
  • In patients 40 to 75 years of age with diabetes mellitus and an LDL-C level of ≥70 mg/dL: Start moderate-intensity statin therapy without calculating their 10-year ASCVD risk.
  • In patients aged 40 to 75 years evaluated for primary ASCVD prevention: Have a clinician–patient risk discussion before starting statin therapy.
  • Assess patient adherence and the percentage response to LDL-C–lowering medications and lifestyle changes with a repeat lipid measurement 4-12 weeks after initiation of statin therapy or dose adjustment; repeat every 3-12 months as needed.

In nondiabetic patients aged 40 to 75 years and with the following characteristics [73, 74] :

  • LDL-C levels ≥70 mg/dL (≥1.8 mmol/L), at a 10-year ASCVD risk of ≥7.5%: Start a moderate-intensity statin if a discussion of treatment options favors statin therapy.

  • A 10-year risk of 7.5-19.9% (intermediate risk): Risk-enhancing factors favor initiation of statin therapy.

  • LDL-C levels ≥70-189 mg/dL (≥1.8-4.9 mmol/L), at a 10-year ASCVD risk of ≥7.5-19.9%: If a decision about statin therapy is uncertain, consider measuring coronary artery calcium (CAC) levels.

 

The American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) now recommend LDL goals of < 55 mg/dL, < 70 mg/dL, < 100 mg/dL, and < 130 mg/dL for individuals at extreme, very high, high/moderate, and low risk for cardiovascular events, respectively, as outlined below. [75]  

Extreme-risk patients: Goals: LDL < 55 mg/dL, non-HDL < 80 mg/dL, apolipoprotein B (apoB) < 70 mg/dL

  • Progressive ASCVD, including unstable angina, in patients after achieving an LDL-C < 70 mg/dL

  • Established clinical cardiovascular disease in patients with diabetes, chronic kidney disease (CKD) stages 3/4, or heterozygous familial hypercholesterolemia (HeFH)

  • History of premature ASCVD (< 55 yr of age in men, < 65 in women)

Very-high-risk patients: Goals: LDL < 70 mg/dL, non-HDL < 80 mg/dL, apoB < 80 mg/dL

  • Established or recent hospitalization for acute coronary syndrome; coronary, carotid, or peripheral vascular disease; 10-y risk >20%

  • Diabetes or CKD stages 3/4 with one or more risk factors

  • HeFH

High-risk patients: Goals: LDL < 100 mg/dL, non-HDL < 130 mg/dL, apoB < 90 mg/dL

  • Two or more risk factors and 10-year risk 10-20%

  • Diabetes or CKD stages 3/4 with no other risk factors

Moderate-risk patients: Goals: Same goals as high risk

  • Two or more risk factors and 10-y risk < 10%

Low-risk patients: Goals: LDL < 130 mg/dL, non-HDL < 160 mg/dL, apoB not relevant

  • 0 risk factors


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!