Non-Medication treatment (Lifestyle Changes)
What types of lifestyle changes can have a positive impact on cholesterol levels?
- Exercise for at least 30 minutes per day almost every day
- Avoid smoking or exposure to smoke
- Avoid excessive alcohol consumption or illicit drug use
- Limit saturated fats to less than 7% of total calories per day. Foods low in saturated include low fat dairy products, lean meats, fish, skinless poultry, whole grain foods, fruits, vegetables and nuts. Two servings of fish are recommended weekly.
- Use vegetable and seed oil such as olive oil, corn oil, soybean, safflower or canola s to replace fats from animal sources.
- Limit trans fats to 0-1% (Trans fats are found in hard margarines)
- Limit cholesterol intake to less than 200 mg/day. Cholesterol is found in organ meats, liver, egg yolks and full fat dairy products.
- Limit total fat intake to less than 30% of calorie intake per day.
- Eat a diet high in fiber (25-30 gm/day) Foods high in soluble fiber such as oats, oranges, pears, brussels sprouts, carrots, dried peas and beans lower LDL levels.
How can someone know what their risk is of having a heart attack within the next ten years?
You can calculate your risk for having a heart attack within the next ten years by (1) looking at the number of major risk factors you have and (2) by using the Framingham Point Scores calculation provided on this site.
- Major risk factors for heart disease include:
- Age (men over 45, women over 55)
- Cigarette smoking
- High Blood pressure greater than 140/90 or on blood pressure medication
- Family history of heart disease in a first degree male relative under the age of 55, or female relative under the age of 65.
- HDL under 40 mg/dl (0.45 mmol/L)
- Presences of diabetes, heart disease or arteriosclerosis
- To calculate your 10 year risk, select the point from each of the 5 categories below that apply to you. Add these points and then use the table provided to determine your risk.
| Estimate of 10 years risk in MEN |
Estimate of 10 years risk in WOMEN |
| Age | Points | |
| 20-34 | -9 | |
| 35-39 | -4 | |
| 40-44 | 0 | |
| 45-49 | 3 | |
| 50-54 | 6 | |
| 55-59 | 8 | |
| 60-64 | 10 | |
| 65-69 | 11 | |
| 70-74 | 12 | |
| 75-79 | 13 | |
|
| Age | Points | |
| 20-34 | -7 | |
| 35-39 | -3 | |
| 40-44 | 0 | |
| 45-49 | 3 | |
| 50-54 | 6 | |
| 55-59 | 8 | |
| 60-64 | 10 | |
| 65-69 | 12 | |
| 70-74 | 14 | |
| 75-79 | 16 | |
|
| | « Points » |
| Total Cholesterol | Age
20-39 | Age
40-49 | Age
50-59 | Age
60-69 | Age
70-79 |
| Less than 160 | 0 | 0 | 0 | 0 | 0 |
| 160-199 | 4 | 3 | 2 | 1 | 0 |
| 200-239 | 7 | 5 | 3 | 1 | 0 |
| 240-279 | 9 | 6 | 4 | 2 | 1 |
| Greater than 280 | 11 | 8 | 5 | 3 | 1 |
|
| | « Points » |
| Total Cholesterol | Age
20-39 | Age
40-49 | Age
50-59 | Age
60-69 | Age
70-79 |
| Less than 160 | 0 | 0 | 0 | 0 | 0 |
| 160-199 | 4 | 3 | 2 | 1 | 1 |
| 200-239 | 8 | 6 | 4 | 2 | 1 |
| 240-279 | 11 | 8 | 5 | 3 | 2 |
| Greater than 280 | 13 | 10 | 7 | 4 | 2 |
|
| | Age
20-39 | Age
40-49 | Age
50-59 | Age
60-69 | Age
70-79 |
| Non-Smoker | 0 | 0 | 0 | 0 | 0 |
| Smoker | 8 | 5 | 3 | 1 | 1 |
|
| | Age
20-39 | Age
40-49 | Age
50-59 | Age
60-69 | Age
70-79 |
| Non-Smoker | 0 | 0 | 0 | 0 | 0 |
| Smoker | 9 | 7 | 4 | 2 | 1 |
|
| HDL (mg/dl) | Points |
| Greater than 60 | -1 |
| 50-59 | 0 |
| 40-49 | 1 |
| Less than 40 | 2 |
|
| HDL (mg/dl) | Points |
| Greater than 60 | -1 |
| 50-59 | 0 |
| 40-49 | 1 |
| Less than 40 | 2 |
|
Systolic Blood Pressure
| (mmHg) Top number BP | If untreated | If treated |
| Less than 120 | 0 | 0 |
| 120-129 | 0 | 1 |
| 130-139 | 1 | 2 |
| 140-159 | 1 | 2 |
| Greater than 160 | 2 | 3 |
|
Systolic Blood Pressure
| (mmHg) Top number BP | If untreated | If treated |
| Less than 120 | 0 | 0 |
| 120-129 | 1 | 3 |
| 130-139 | 2 | 4 |
| 140-159 | 3 | 5 |
| Greater than 160 | 4 | 6 |
|
| Total Points | 10 year risk |
| 16 or greater | risk greater than 20% |
| 12-15 | risk 10-20% |
| 11 or less | risk less than 10% |
|
| Total Points | 10 year risk |
| 23 or greater | risk greater than 20% |
| 20-22 | risk 10-20% |
| 19 or less | risk less than 10% |
|
Data from NIH Publicaton N0. 01-3305 May 2001
How does risk for heart attack impact treatment choices?
Patients who have a higher risk for a heart attack often need to be treated more aggressively. Their cholesterol levels should be kept lower than patients with fewer risk factors and medication needs to be added to lifestyle changes earlier in the course of treatment.
Before choosing the best treatment the health care provider will consider:
- The Heart attack Risk category
- LDL, HDL and Triglyceride levels
- Medical history (i.e. previous heart attack, heart disease, diabetes, arteriosclerosis, blood pressure)
| Category |
LDL Goal |
Treatment Lifestyle Choices |
Consider Medications |
Category I High Risk
Risk more than 20%
Or heart disease, diabetes or arteriosclerosis |
Less than 100 mg/dl
(may be 70mg/dl or less in more high risk cases) |
Even if LDL is less than 100 mg/dl a heart healthy diet and exercise is important with this high risk. |
Start medications if LDL is 100 mg/dl or above.
May need medication if LDL is 100 mg/dl or lower if the patient has suffered a recent heart attack, has diabetes or heart disease. |
Category II Next Highest Risk
Risk score 10-20% and 2 or more risk factors |
Less than 130 mg/dl |
If LDL is 130 mg/dl or higher. |
May need medication if goal is not reached within 3 months. |
Category III Moderate Risk
Risk score less than 10% and 2 or more risk factors |
Less than 130 mg/dl |
If LDL is 130 mg/dl or higher |
May need medication if LDL is 160 mg/dl or higher after 3 months of diet and exercise. |
Category IV Low to Moderate Risk
0 to 1 risk factor |
Less than 160 mg/dl |
If LDL is 160 mg/dl or higher |
May need medication if goal is not reached within 6 months, particularly if LDL is 190 mg/dl or higher. |
