{"id":2418,"date":"2025-11-20T22:00:45","date_gmt":"2025-11-21T04:00:45","guid":{"rendered":"https:\/\/drakarlacastolo.com\/?p=2418"},"modified":"2025-11-30T20:11:43","modified_gmt":"2025-12-01T02:11:43","slug":"ldl-cholesterol-diagnostic-evaluation-objectives","status":"publish","type":"post","link":"https:\/\/drakarlacastolo.com\/en\/blog\/diagnostic-evaluation\/ldl-cholesterol-diagnostic-evaluation-objectives\/","title":{"rendered":"LDL cholesterol: current targets and how to achieve them"},"content":{"rendered":"<p>LDL cholesterol (\u201cbad cholesterol\u201d) is one of the strongest determinants of cardiovascular risk. <strong>Lowering it in a sustained manner reduces heart attacks and cerebral events.<\/strong> Here you will see the <strong>LDL targets<\/strong> according to your level of risk and <strong>how to achieve them<\/strong> combining habits and treatment.<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p><strong>Short notice:<\/strong> This guide is informative and does not replace your medical plan. Customize each step in a <strong><a href=\"https:\/\/drakarlacastolo.com\/en\/contact\/\" data-type=\"link\" data-id=\"https:\/\/drakarlacastolo.com\/contacto\/\">clinical cardiology consultation<\/a><\/strong>.<\/p>\n<\/blockquote>\n\n\n\n<h2 class=\"wp-block-heading\">LDL-C goals according to your risk<\/h2>\n\n\n\n<p>International guidelines recommend different LDL targets depending on the risk of each individual:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Risk<\/th><th>LDL-C target<\/th><th>Clues to locate you<\/th><\/tr><\/thead><tbody><tr><td><strong>Very high<\/strong><\/td><td><strong>&lt; 55 mg\/dL<\/strong> and\/or <strong>\u2265 50 %<\/strong> of reduction<\/td><td>Previous infarction\/angina, stent, peripheral artery disease, diabetes with organ damage<\/td><\/tr><tr><td><strong>High<\/strong><\/td><td><strong>&lt; 70 mg\/dL<\/strong> and\/or <strong>\u2265 50 %<\/strong> of reduction<\/td><td>Several risk factors (hypertension, smoking, high cholesterol, family history)<\/td><\/tr><tr><td><strong>Moderate<\/strong><\/td><td><strong>&lt; 100 mg\/dL<\/strong><\/td><td>1-2 risk factors, no established cardiovascular disease<\/td><\/tr><tr><td><strong>Under<\/strong><\/td><td><strong>&lt; 116 mg\/dL<\/strong><\/td><td>Young adults without comorbidities<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p>If you have already had a heart attack or had a stent placed, prevention does not end at the hospital. It can be key to complement your care with <strong><a>Cardiac rehabilitation<\/a><\/strong>.<\/p>\n<\/blockquote>\n\n\n\n<h2 class=\"wp-block-heading\">How to reach your goals (practical route)<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">1) Lifestyle with real impact<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Cardioprotective nutrition<\/strong> (Mediterranean\/DASH):\n<ul class=\"wp-block-list\">\n<li>Less saturated fats (sausages, processed meats, full-fat dairy products) and trans fats.<\/li>\n\n\n\n<li>More <strong>soluble fiber<\/strong> (oats, legumes, fruits, vegetables), fish and olive oil.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Aerobic physical activity:<\/strong> at least 150 minutes per week (brisk walking, cycling, swimming).<br>If you are just starting out or want to train with more intensity, you may find it useful to have a <strong><a>Stress test<\/a><\/strong> to set safe zones.<\/li>\n\n\n\n<li><strong>Healthy weight:<\/strong> losing 5-10 % of initial weight already improves the lipid profile.<\/li>\n\n\n\n<li><strong>Zero tobacco<\/strong> and moderate or no alcohol.<\/li>\n<\/ul>\n\n\n\n<p><em>Expected reduction of LDL with habits alone:<\/em> around <strong>5-15 %<\/strong>. In people at high or very high risk, additional pharmacological treatment is almost always required.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">2) First line: statins<\/h3>\n\n\n\n<p>The <strong>statins<\/strong> are the basis of treatment to lower LDL:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>They can reduce LDL between <strong>30 and 60 %<\/strong> depending on the dose and type.<\/li>\n\n\n\n<li>In high or very high risk, we recommend doses of <strong>high intensity<\/strong>, for example:\n<ul class=\"wp-block-list\">\n<li><strong>Atorvastatin 40-80 mg<\/strong><\/li>\n\n\n\n<li><strong>Rosuvastatin 20-40 mg<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>It is common to repeat the <strong>lipid profile at 4 to 12 weeks<\/strong> to start or adjust doses to verify that you are on target.<\/p>\n\n\n\n<p>If this is your first cardiology evaluation or you have experienced palpitations or chest pain, your physician may rely on a <strong><a>Electrocardiogram (ECG)<\/a><\/strong> or other studies to get a more complete picture of your risk.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">3) When a statin is not enough: ezetimibe<\/h3>\n\n\n\n<p>If with the best tolerated statin dose <strong>you do not reach your LDL target<\/strong>, the usual next step is to add <strong>ezetimibe<\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Typical dose: 10 mg per day.<\/li>\n\n\n\n<li>May reduce LDL <strong>15-25 Additional %<\/strong>.<\/li>\n\n\n\n<li>Generally well tolerated and easy to use.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">4) Very high risk and familial hypercholesterolemia: PCSK9 inhibitors.<\/h3>\n\n\n\n<p>In people of <strong>very high risk<\/strong> (previous heart attacks, multiple events, very high LDL) or with <strong>familial hypercholesterolemia<\/strong>, can be considered the use of <strong>PCSK9 inhibitors<\/strong> (such as evolocumab or alirocumab):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The following apply <strong>subcutaneously<\/strong> every 2-4 weeks.<\/li>\n\n\n\n<li>LDL levels are very markedly lowered (additional reduction of <strong>50-60 %<\/strong>).<\/li>\n\n\n\n<li>They have been shown to reduce infarctions, the need for new procedures and some cardiovascular mortality outcomes.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">5) Other options in specific cases<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Inclisiran:<\/strong> interfering RNA-based drug administered every 6 months; useful when adherence to daily pills is difficult.<\/li>\n\n\n\n<li><strong>Bempedoic:<\/strong> oral option designed for some patients with <strong>statin intolerance<\/strong>.<\/li>\n\n\n\n<li><strong>Purified Omega-3:<\/strong> do not lower LDL, but they do help when they are <strong>triglycerides<\/strong> are elevated.<\/li>\n<\/ul>\n\n\n\n<p>The choice of each drug depends on your medical history, other conditions, previous studies and specific goals.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Follow-up schedule (0-12 weeks)<\/h2>\n\n\n\n<p>A practical scheme could look like this:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Week 0<\/strong>\n<ul class=\"wp-block-list\">\n<li>Global risk assessment and definition of LDL target.<\/li>\n\n\n\n<li>Statin initiation or adjustment.<\/li>\n\n\n\n<li>Initiation of lifestyle changes.<\/li>\n\n\n\n<li>In patients with several risk factors or a family history, it may be useful to have a <strong><a>Cardiac check-up<\/a><\/strong> to integrate blood pressure, electrocardiogram and other studies.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Week 4-6<\/strong>\n<ul class=\"wp-block-list\">\n<li>Adherence check: did you take the medications every day, were there any side effects?<\/li>\n\n\n\n<li>Dose adjustments if necessary.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Week 8-12<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>New lipid profile<\/strong> to confirm if LDL is at the target range.<\/li>\n\n\n\n<li>If LDL continues to <strong>over the target<\/strong>, add <strong>ezetimibe<\/strong>.<\/li>\n\n\n\n<li>If, despite statin + ezetimibe, you are still far from the target and your risk is very high, consider <strong>PCSK9 inhibitors<\/strong>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>In those who also have hypertension or discordant blood pressure data (different figures at home and in the office), follow-up can be supported with the <strong><a href=\"https:\/\/drakarlacastolo.com\/en\/studies\/\">cardiological studies<\/a><\/strong> (e.g., ambulatory blood pressure monitoring).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Safety and warning signs<\/h2>\n\n\n\n<p>Although most patients tolerate treatment well, it is important to be vigilant:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Muscle pain or weakness<\/strong> persistent, especially if accompanied by fever or extreme tiredness.<\/li>\n\n\n\n<li><strong>Darker than usual urine<\/strong> or important general symptoms.<\/li>\n\n\n\n<li><strong>Alterations in liver tests<\/strong> (they are checked in control laboratories).<\/li>\n<\/ul>\n\n\n\n<p>In addition, any <strong>oppressive chest pain, severe shortness of breath, fainting, or sustained palpitations with malaise<\/strong> requires immediate medical evaluation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What do we measure besides LDL?<\/h2>\n\n\n\n<p>In some cases, your cardiologist may order additional studies to refine the risk:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>ApoB:<\/strong> indicates the total amount of atherogenic particles (those most associated with plaque formation).<\/li>\n\n\n\n<li><strong>Lipoprotein(a):<\/strong> is evaluated especially if there is <strong>family history of early infarction<\/strong> or premature cardiovascular disease.<\/li>\n<\/ul>\n\n\n\n<p>These parameters can be integrated into a <strong><a>cardiological check-up<\/a><\/strong> complete.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What does success in LDL control look like?<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>LDL at goal<\/strong> defined for your level of risk (and many times <strong>\u2265 50 % minus<\/strong> than your initial value).<\/li>\n\n\n\n<li><strong>Well tolerated treatment<\/strong>, without relevant adverse effects.<\/li>\n\n\n\n<li><strong>Sustainable habits<\/strong> diet, exercise and not smoking.<\/li>\n\n\n\n<li>Lower probability of future infarction, cardiac procedures and cerebrovascular events.<\/li>\n<\/ul>\n\n\n\n<p>If you have doubts about what your cholesterol goals should be or are unsure if your current treatment is sufficient, you can <strong><a>schedule your assessment<\/a><\/strong> to review studies, adjust the plan and define clear objectives.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References (clickable)<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>AHA\/ACC 2018\/2019 Cholesterol Guideline (Circulation):<br><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000625\" target=\"_blank\" rel=\"noopener\">https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000000625<\/a><\/li>\n\n\n\n<li>ESC\/EAS 2019 Dyslipidaemia Guideline (European Heart Journal):<br><a href=\"https:\/\/academic.oup.com\/eurheartj\/article\/41\/1\/111\/5556353\" target=\"_blank\" rel=\"noopener\">https:\/\/academic.oup.com\/eurheartj\/article\/41\/1\/111\/5556353<\/a><\/li>\n\n\n\n<li>ACC 2022 Expert Consensus on Nonstatin Therapies (JACC):<br><a href=\"https:\/\/www.jacc.org\/doi\/10.1016\/j.jacc.2022.07.006\" target=\"_blank\" rel=\"noopener\">https:\/\/www.jacc.org\/doi\/10.1016\/j.jacc.2022.07.006<\/a><\/li>\n\n\n\n<li>FOURIER - Evolocumab Outcomes (NEJM):<br><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1615664\" target=\"_blank\" rel=\"noopener\">https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1615664<\/a><\/li>\n\n\n\n<li>ODYSSEY OUTCOMES - Alirocumab (NEJM):<br><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1801174\" target=\"_blank\" rel=\"noopener\">https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1801174<\/a><\/li>\n\n\n\n<li>Bempedoic Acid in Statin-Intolerant Patients (NEJM 2023):<br><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2215024\" target=\"_blank\" rel=\"noopener\">https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2215024<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>El colesterol LDL (\u201ccolesterol malo\u201d) es uno de los determinantes m\u00e1s fuertes del riesgo cardiovascular. Bajarlo de forma sostenida reduce infartos y eventos cerebrales. Aqu\u00ed ver\u00e1s las metas de LDL seg\u00fan tu nivel de riesgo y c\u00f3mo lograrlas combinando h\u00e1bitos y tratamiento. Aviso breve: Esta gu\u00eda es informativa y no sustituye tu plan m\u00e9dico. Personaliza [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":2419,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2418","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-evaluacion-diagnostico"],"acf":[],"_links":{"self":[{"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/posts\/2418","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/comments?post=2418"}],"version-history":[{"count":0,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/posts\/2418\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/media\/2419"}],"wp:attachment":[{"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/media?parent=2418"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/categories?post=2418"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drakarlacastolo.com\/en\/wp-json\/wp\/v2\/tags?post=2418"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}