After a coronary event, managing your cholesterol levels is more important than ever. But what do the numbers mean, and what should you strive for? Talk with your doctor about your individual cholesterol goals, but until you do, here is an overview of cholesterol testing.
Cholesterol Testing: How It’s Done
Your body makes cholesterol naturally, or you can get it from food. You need cholesterol to make bile acids, fat-soluble vitamins, and certain hormones. Cholesterol also helps make up the outer layer of cells in your body and keeps your cells working properly.
But because cholesterol is a waxy, fat-like substance, too much of it can stick to the walls of your arteries or blood vessels, clogging them. This makes it harder for your blood to flow, causing your heart muscle to pump harder. High cholesterol can raise your risk for heart disease and stroke.
Since high cholesterol can raise your risk for heart disease and stroke, it’s important for everyone to know their cholesterol levels. But as someone who has already had a coronary event, it’s really crucial to keep tabs on your numbers.
Your LDL cholesterol has the nickname, "bad" cholesterol, because at high levels it causes fatty deposits called plaques to build up in your arteries or blood vessels. This is called atherosclerosis, and it’s what slows, and can stop your blood flow. If plaques rupture, you can have a coronary event like a heart attack or stroke.
After a coronary event, your doctor may want to test your cholesterol more often because you're at a higher risk for another event. Your doctor will likely test your cholesterol annually.
When your doctor tests your cholesterol, they’re looking to measure several markers in your blood.
High-density lipoprotein (HDL). Often called "good" cholesterol, HDL is associated with a lower risk of heart attack and stroke.
Low-density lipoprotein (LDL). Your LDL, or "bad," cholesterol can not be measured directly and is estimated using your HDL, total cholesterol, and triglyceride numbers.
Total cholesterol. This number measures the total amount of fats in your bloodstream. The number is based on your HDL, LDL, and triglycerides numbers.
Non-HDL. This number tells you how much "bad" cholesterol is in your blood by subtracting your HDL from your total cholesterol. Non-HDL includes your LDL and the other types of cholesterol like very-low-density lipoprotein (VLDL) and lipoprotein A (Lp(a)).
Triglycerides. Your body uses this fat in your blood for energy. But if you have too many triglycerides and low HDL or high LDL levels, your risk of heart attack or stroke goes up.
The test for Lp(a) is not routinely part of the lipid panel, but your doctor may order it if you are at a higher risk for another coronary event. Higher levels of this type of LDL cholesterol can put you at higher risk for cardiovascular disease.
These numbers make up your lipid profile or lipid panel. Your doctor gets these tests done from a sample of your blood.
A laboratory instrument mixes chemicals into your blood sample and measures the different colors of light that your blood puts out. This tells them how much free cholesterol is in your blood as well as the amount of cholesterol in the outer layer of your cells.
Target Numbers
For people looking to know where to target their cholesterol numbers after a coronary event, talking to your doctor can help you aim for the best levels. After a coronary event, many doctors recommend lowering cholesterol targets lower than before.
LDL cholesterol targets. Studies have shown that when LDL, or "bad," cholesterol drops below 70 mg/dL, plaques in arteries get smaller and can stabilize. This can also lower your risk for heart attacks and stroke. Some clinical guidelines suggest lowering your "bad" LDL cholesterol below 55 mg/dL, while other guidelines simply recommend that you cut your LDL levels in half.
HDL cholesterol targets. An HDL, or "good," cholesterol target above 60 mg/dL is a good place to start. But an HDL level below 40 mg/dL can put you at higher risk for another coronary event. Try to stay active and exercise to raise your HDL.
Non-HDL cholesterol targets. A non-HDL cholesterol target to aim for is 100 mg/dL, which can lower your risk for another coronary event.
After you have a coronary event, doctors recommend that you start treatment to lower non-HDL cholesterol as soon as possible. In fact, studies say the earlier, more, and longer you lower levels, the better. Talk with your doctor about cholesterol-lowering medications, and find out which options work best for you.
Make a Plan With Your Doctor
Your cholesterol-lowering plan will start while you’re still in the hospital, if your coronary event requires a stay. Your team will want to lower your "bad" LDL cholesterol as quickly as possible, and will likely start you on a lipid-lowering medication called a statin.
If you’ve already been on statins before your coronary event, your doctor will likely intensify your therapy and add in another drug called ezetimibe, which lowers cholesterol in a slightly different way compared to statins.
If your levels aren’t falling as quickly as your doctor wants them to, you may also need to take a type of medication called a PCSK9 inhibitor. Quickly lowering non-HDL cholesterol levels with an aggressive treatment plan helps reduce your risk of another coronary event compared to slowly adding intensive treatments over time.
Alongside your medical treatment, your doctor will help you with heart-healthy lifestyle changes to aid in hitting your target cholesterol numbers. These include:
- Regular exercise
- Heart-healthy diet
- No smoking
- Regular checkups
The checkups monitor your blood pressure and cholesterol. And you’ll need to come back for cholesterol checks at regular intervals after you begin treatment. The schedule may look like:
- First checkup after four to 6 weeks
- Second checkup after eight to 12 weeks
- Third checkup after 6 months
- Fourth checkup at 1 year
Depending on how you’re doing, your doctor will want to see you yearly to make sure your cholesterol levels are still on track.
Questions for Your Doctor
As you work actively to lower your cholesterol after your coronary event, be sure to review all your information about the event and your condition. Write down and log any symptoms, changes in weight, and your blood pressure.
Come prepared for your doctor’s visits to ask these questions about cholesterol and your heart health.
- How often should I have my cholesterol checked?
- Should I fast before my cholesterol test?
- What are my target goals for my cholesterol numbers?
- Do I need medical treatment for my cholesterol, and if so, which one is best?
- What side effects are common from my cholesterol medications?
- What are some lifestyle changes that I can make to help lower my cholesterol levels?
- How likely am I to have another coronary event?
- Is it OK for me to exercise? Will that help my cholesterol levels?
- What coronary symptoms are signs that I should call a doctor?
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
National Institute of Standards and Technology: "How Do You Measure Cholesterol in Blood Tests?"
British Heart Foundation: "Should I Be Seeing My GP More After My Heart Attack?," "Understanding Your Cholesterol Levels," "What to Ask Your Doctor When You’ve Just Been Diagnosed With a Heart Condition."
Mayo Clinic: "Cholesterol Test," "HDL Cholesterol: How to Boost Your 'Good' Cholesterol."
MedlinePlus: "Cholesterol Levels: What You Need to Know."
Cleveland Clinic: "Lipoprotein (a)."
CDC: "Testing for Cholesterol."
ADLM: "The New Lipid Panel Playbook," "Understanding Lipoprotein(a) Testing."
National Heart, Lung, and Blood Institute: "Blood Cholesterol."
Harvard Health: "How Low Should LDL Cholesterol Go?"
UpToDate: "Low-Density Lipoprotein-Cholesterol (LDL-C) Lowering After an Acute Coronary Syndrome."
American College of Cardiology: "2018 Guideline on the Management of Blood Cholesterol."
Clinical Cardiology: "Management of LDL‐cholesterol after an acute coronary syndrome: key comparisons of the American and European clinical guidelines to the attention of the healthcare providers."
Pharmacological Research: "Optimal use of lipid-lowering therapy after acute coronary syndromes: a position paper endorsed by the International Lipid Expert Panel (ILEP)."
Nature Review Molecular Cell Biology: "Mechanisms and regulation of cholesterol homeostasis."
