Cardiologist Dr. Paul D. Thompson, MD, explains that no single cholesterol number is high for everyone. He describes how diabetes, a previous heart attack and overall risk change the LDL cholesterol level he aims for.
LDL Cholesterol Targets: Why the Right Level Depends on Personal Risk
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- High depends on personal risk
- Lower targets with diabetes or a past heart attack
- Targets for most people
- Full Transcript
High depends on personal risk
Whether a cholesterol level counts as high depends on the person's other risk factors, says cardiologist Dr. Paul D. Thompson, MD. He calls the question from Dr. Anton Titov, MD, a really tough one.
Lower targets with diabetes or a past heart attack
Diabetes is almost equivalent to having had a heart attack, in Dr. Thompson's view. For people with diabetes, he says, doctors like LDL cholesterol below 55 milligrams per deciliter, the unit he uses in the United States. In millimoles, he puts this at about 1.4 or 1.5.
For people who have had a heart attack, he also wants the level low. He explains why with a third grade teacher who asks the second grade teacher which children will cause trouble: in the same way, the patients who will give a cardiologist trouble are those who have already had a heart attack. For them, he says, doctors are very aggressive and aim for about 55.
Targets for most people
For most people, Dr. Thompson says, doctors like LDL cholesterol at 100 or below, and the riskier the person, the lower they try to get it. He says there are all sorts of formulas for this, which he keeps on his smartphone rather than in his head.
Full Transcript
Dr. Anton Titov, MD: What cholesterol level counts as 'high'?
Dr. Paul D. Thompson, MD: That is a really tough question, because it depends. What does it depend on? It depends on how risky you are, your other risk factors.
Dr. Paul D. Thompson, MD: So let us take somebody with diabetes. If you have got diabetes, we know that that is almost like having a heart attack, because your prognosis after a heart attack is lower than if you had never had a heart attack. So if you have diabetes, it is almost equivalent to having had a heart attack.
Dr. Paul D. Thompson, MD: So we like the LDL cholesterol, and I deal in milligrams per deciliter because I am in the United States, but we like the LDL cholesterol below 55. Now, in millimoles, that is about, let me just do the math in my head, that is about 1.4 or 1.5. Now, if you have had a heart attack, we want your cholesterol level low as well.
Dr. Paul D. Thompson, MD: Why? Let us suppose that I teach third grade. If I want to know which kids are going to give me trouble in third grade, whom do I ask?
Dr. Paul D. Thompson, MD: I ask the second grade teacher, because the kid who gave you trouble in second grade is the kid that is going to give you trouble in third grade. As a cardiologist, if I want to know which patients are going to give me trouble, who do I look for?
Dr. Paul D. Thompson, MD: The people that have already had a heart attack. So if somebody has already had a heart attack, we are very aggressive about lowering their LDL cholesterol. We like to get it down to about 55.
Dr. Paul D. Thompson, MD: For most people, we like their LDL cholesterol at 100 or below. The riskier you are, the lower we try to get it. And there are all sorts of formulas that we do.
Dr. Paul D. Thompson, MD: I do not keep them in my head. I have them on my smartphone. So how low you want your cholesterol depends.
Dr. Paul D. Thompson, MD: It depends on how risky you are.