Lifestyle modification and often in conjunction with cholesterol-lowering drug therapy are the main cornerstones in the management of high cholesterol. Life style modification include proper diet, regular exercise, smoking cessation, and weight control.
The main drug therapy for high cholesterol is statin. The preponderance of evidence from clinical trials suggest that statin is the only cholesterol medication that lowers the risk of atherosclerotic disease. The new AHA 2013 cholesterol guideline moves away from treatment of lipid disorder based on target cholesterol level. The new focus is on identifying the four major groups of patients that should be treated with statin.
Group 1: Patients with known atherosclerotic disease. These are patients with coronary heart disease, heart attack, stroke, and peripheral arterial disease presumed to be of atherosclerotic origin.
Group 2: Patients with extremely elevated LDL-C level ≥190 mg/dL.
Group 3: Patients with diabetes.
Group 4: Patients who have an estimated 10-yr risk of developing atherosclerotic cardiovascular disease ≥ 7.5%.
Other considerations: Other clinical factors that might be considered for statin therapy include LDL-C ≥ 160 mg/dL and other genetic hyperlipidemias, history of premature heart disease in the family, high CRP protein, high calcium score, low ankle brachial index, or elevated lifetime risk of atherosclerotic disease.
The new kidney guideline from KDIGO (Kidney Disease: Improving Global Outcomes) suggest that adults age ≥ 50 years with chronic kidney disease but not treated with chronic dialysis or kidney transplantation should be treated with a statin.