LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC)

Risk Category	LDL Goal	LDL Level at Which to Initiate Therapeutic Lifestyle Changes (TLC)	LDL Level at Which to Consider Drug Therapy
CHD or CHD Risk Equivalents (10-year risk >20%)	<100 mg/dL	≥100 mg/dL	≥130 mg/dL (100-129 mg/dL: drug optional)*
2+ Risk Factors (10-year risk 20%)	<130 mg/dL	≥130 mg/dL	10-year risk 10-20%: ≥130 mg/dL 10-year risk <10%: ≥160 mg/dL
0-1 Risk Factor**	<160 mg/dL	≥160 mg/dL	≥190 mg/dL (160-189 mg/L: LDL-lowering drug optional)

* Some authorities recommend use of LDL-lowering drugs in this category if an LDL cholesterol <100 mg/dL cannot be achieved by therapeutic lifestyle changes. Others prefer use of drugs that primarily modify triglycerides and HDL, e.g., nicotinic acid or fibrate. Clinical judgment also may call for deferring drug therapy in this subcategory.

** Almost all people with 0-1 risk factor have a 10-year risk <10%, thus 10-year risk assessment in people with 0-1 risk factor is not necessary.

References:

2) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.