It’s easy to see just how difficult it is for doctors to recommend the right advice.  For many doctors, it is too time-consuming to do this “properly” for each patient.  Unfortunately, most doctors I know “kind of” know the guidelines, and give an “educated guess” to the patient.  I have seen that a lot of my friends are getting “good guesses” from their doctors, but they are not “spot on.”

This bothers me. The ATP III guidelines were thoroughly researched to get best results for patients to not develop heart disease.  And even though your cholesterol or LDL may look low, it may not be low enough to get you to best results without medication (if you have certain risk factors).  On the other hand, your cholesterol may look high, but considering your lack of risk factors and a good HDL, it may in fact be just fine, and you don’t need to be on the cholesterol medication your doctor recommended just from “eyeballing” your cholesterol.

I would like for every patient to correctly be on (or off) the right medications.  I hate to think of a patient getting told that he or she doesn’t need cholesterol medication, when it could really save his or her life.  And I don’t want a patient to be on a medication that they don’t need.

So, you have to do the math to get to the right decision, and it’s not particularly easy, but I’m going to show you how to do it.  Remember, your doctor may not take this much time to get to the absolutely correct decision—so you need to do it.

Visit National Cholesterol Educational Program to see all the information on what are optimal or desirable levels of cholesterol and LDL— but go past all that information until you get to, “What Is Your Risk of Developing Heart Disease or Having a Heart Attack?” and follow steps 1 through 3.  You’ll then know what risk category you are in:  High Risk, Next Highest Risk, Moderate Risk, or Low-to-Moderate Risk.  Consider checking your calculations twice to make sure that you’ve put yourself in the right category.

(After completing Step 1, if you find you have two or more Major Risk Factors, then you’ll need to look closely at Step 2.  The link you will find there will take you to another evaluation tool that will help you determine your percentage Risk Score.  Then with the information from Step 1 and Step 2, you’ll be able to accurately place yourself in the appropriate risk category.)

Then continue down the page to “Treating High Cholesterol.”  Here, you will see that there are two methods we use to treat high cholesterol:  “Therapeutic Lifestyle Changes” (TLC) and cholesterol-lowering drugs.

Find your risk category, and see exactly what you should be doing.  Then finish reading the rest of the handout, reading the first part as well, so you understand as much as possible.  But the most important part is finding what risk category you’re in, and then closely following the treatment outlined under that risk category.

For example, if your risk category is, “Next Highest Risk,” which says your LDL goal is less than 130, and yours is 145, then you need to begin the TLC diet as it says; but if you’ve done that for 3 months and it’s now 135, then you need to also start on drug treatment.

We no longer give patients diet advice only and then hope that it works.  We now know that sometimes the best advice is to immediately start following the TLC diet and begin taking drugs or sometimes to start only the TLC diet right away; but always to check back and alter doses or add drugs as needed to get you to your goal, considering your risk factors (i.e., considering what risk category you’re in).

So do it for yourself, your spouse and your parents, and if they should be on a cholesterol-lowering drug (according to this protocol), then make sure they get it from their doctor.

And make sure you get your cholesterol to goal.  Don’t wait around forever trying to do it with diet, if that’s not working for you.  It’s more important that you start saving wear-and-tear on your heart as soon as possible—so be smart and follow these guidelines.

And if you’re someone like me, with a cholesterol of 230 and LDL of 150—a person who doctors like to “eyeball” and reflexively prescribe a cholesterol drug to—but you’ve done the calculation and found out (because of zero risk factors) that you’re in the lowest category – then you’ll find that you don’t need drugs or the TLC diet, so you won’t be taking any unnecessary medication.

One caveat:  when the recommendation says, “then you will need to follow the heart healthy diet for all Americans”— that means that you’re really fine and you don’t need to do anything special to help your cholesterol or alter your diet or be on the TLC diet.  But they are just saying, “you need to follow the heart healthy diet for all Americans” because, as a general recommendation, that’s really the smart thing for all of us to be doing.