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Understanding Cholesterol – The Good, Bad, and Guidelines

Dr. Brown is a noted family physician and international and national speaker on health prevention, wellness, continuing medical education and women’s health. She is a member of numerous advisory bodies for both the provincial and federal government, helping make decisions regarding healthcare of Canadians. She was awarded, Family Physician of the Year, 2012 by the Ontario College of Family Physicians.

Profile: www.linkedin.com/in/drvivienbrown

Heart disease is the number one cause of death in Canada, which makes prevention of heart disease so important. Some risk factors for heart disease unfortunately cannot be changed, including your genes, gender and ethnicity. There are many other factors, however, that you can control. These are called modifiable risk factors, and include high blood pressure, obesity, smoking, diet, exercise levels, and high cholesterol. But what level of cholesterol is considered to be high, and how does your doctor determine whether or not cholesterol-lowering medication is right for you?

You may have heard of “good” cholesterol and “bad” cholesterol. Good cholesterol is called HDL and bad cholesterol is LDL. LDL cholesterol is used as the primary target when deciding whether your cholesterol is at target or not. Target cholesterol levels differ according to risk category; if you are a low-risk individual, we accept higher LDL levels than we do for high-risk individuals. So the first step that your doctor takes when assessing your cholesterol profile is determination of your risk category. This is done by calculating what’s called a Framingham Risk Score, which takes into account your age, gender, total and HDL cholesterol levels, smoking status, blood pressure, family history, and whether or not you have diabetes.

A Framingham Risk Score of less than 10% is considered low-risk, and for these individuals an LDL level of less than 5.0 is considered acceptable. Individuals with a risk score of less than 5% can have their cholesterol rechecked in 3-5 years, while those with a risk score of 5-9% should have their cholesterol levels repeated yearly. Framingham Risk Scores between 10 and 19% fall into the moderate-risk category. The target LDL level for moderate-risk individuals is <3.5. Levels greater than 3.5 should be treated with cholesterol-lowering medication. However, cholesterol-lowering medication will also be recommended if your LDL is less than 3.5, but a different marker called non-HDL is elevated. Finally, Framingham Risk Scores of 20% or greater are considered high-risk. Treatment with cholesterol-lowering medications will be considered for all high-risk patients, regardless of LDL cholesterol levels.

Your doctor will discuss the specifics of cholesterol-lowering medication with you if it is indicated based on these guidelines. For some individuals, lifestyle modification can be tried before medication in order to help lower cholesterol levels. For others, however, medication may be required at the outset depending on risk level and degree of elevation of cholesterol levels. Whether you require cholesterol-lowering medication or not, everyone should try to implement the Canadian Cardiovascular Society’s recommendations for a heart-healthy lifestyle:

  • Diet with reduced saturated fats and refined sugars
  • Weight reduction and maintenance
  • Exercise: 150 mins/week of moderate activity (i.e. brisk walking, biking, swimming, etc)
  • Smoking cessation
  • Limit alcohol to no more than 1-2 drinks/day

To learn more about dietary fats from the Heart & Stroke Foundation, click here:


Dr. Vivien Brown, MDCM, CCFP, FCFP, NCMP,
Vice-President, Medical Affairs, Medisys Health Group