Why you need to follow your cholesterol treatment plan

If a blood test shows you have worrisome levels of cholesterol—a waxy substance found in your blood—your healthcare provider (HCP) may want to talk about some lifestyle changes and starting medication to help control your cholesterol levels. One of the numbers that often causes concern is known as low-density lipoprotein, or LDL cholesterol. Sometimes, it’s called “bad” cholesterol because it is linked to heart disease and other problems.

You might think, “Well, I don’t feel sick or have any symptoms of high cholesterol.” But high LDL usually causes no outward symptoms—even as it’s silently causing trouble inside.

And LDL isn’t the only fat (lipid) in the blood. A total cholesterol test will also reveal levels of:

• High-density lipoprotein, or HDL cholesterol: HDL is often described as the “good” cholesterol because it clears LDL cholesterol from the blood.

• Very low-density lipoprotein (VLDL): VLDL is a type of cholesterol that carries triglycerides through the blood. It is considered a "bad" lipoprotein just like LDL. High levels can cause plaque to build up in the arteries and lead to heart disease.

• Triglycerides: This is a type of fat in the blood that the body uses for energy. High levels of triglycerides increase your risk of heart disease.

If both LDL and HDL goals are met, a third “goal” or blood test your HCP may consider is your Apolipoprotein B level. ApoB is a protein that may contribute to the buildup of cholesterol in artery walls.

When should high cholesterol be treated?

A total cholesterol level of 240 mg/dL (milligrams per deciliter) or greater is considered high. But a “borderline” level between 200 to 239 mg/dL means you are at higher risk for heart disease, especially if you have other risk factors such as high blood pressure.

So, the rule of thumb is to keep your:

• Total cholesterol less than 200
• “Bad” LDL less than 130 (depending on your individual health history and risk factors, your LDL goal may be 70 mg/dL, or even 55 mg/dL)
• “Good” HDL (it absorbs cholesterol in the blood) more than 60
• Triglycerides less than 150

Many factors go into deciding if your cholesterol levels should be treated. Along with your test results, your HCP will typically consider your overall health and any heart disease risk factors. Those factors include:

• High blood pressure
• Prediabetes or diabetes
• Overweight or obesity
• Smoking
• Family history of heart disease

In addition to your cholesterol levels, it’s important to consider your 10-year risk for heart disease. This is a calculation of your chance of developing heart disease—heart attack, stroke, peripheral artery disease and heart failure, among others—within the next 10 years. It takes cholesterol into account, but also other variables and risk factors, such as age, blood pressure and treatment for high blood pressure, diabetes, and smoking.

For some people, their 30-year risk for heart disease should also be considered. Guidelines about the use of cholesterol-lowering drugs called statins were updated in March 2026 to protect younger patients who may be considered low risk for the next decade but face a high lifetime risk of cardiovascular events. So, if you are between 39 and 59 years old and have a low 10-year risk, your healthcare provider (HCP) will also calculate your 30-year risk to determine what treatment plan (if any) is best for you.

Starting with a lifestyle approach

The first step in managing cholesterol levels is to consider your daily habits. There are some healthy lifestyle changes that can help lower LDL and triglycerides and increase beneficial HDL. These include:

• Eating a heart-healthy diet, prioritizing fruits, vegetables, whole grains, and lean meats while reducing intake of trans and saturated fats
• Increasing your level of physical activity
• Losing weight
• Quitting smoking

If lifestyle changes don’t reduce your numbers far enough or if your LDL is particularly high to begin with (typically 160 mg/dL)—or if your other heart risk factors necessitate more aggressive treatment—your HCP may add another element to your treatment plan: cholesterol-lowering medication. Statins are the primary class of drugs that do this work.

How medication can improve your heart health

If you have existing cardiovascular disease (CVD) or a history of a heart attack, you’ll likely be prescribed a statin. If you don’t already have CVD but have a high risk for it, your HCP may still prescribe a statin even if your cholesterol levels are considered “normal.” Studies suggest that treating people with high risk for CVD but no existing disease might help fend off health issues related to LDL.

What does limiting LDL levels do for you?

LDL promotes buildup—of cholesterol, fatty substances, cellular waste products, calcium and clotting materials—on the walls of blood vessels feeding the heart. This disease, which also stiffens and narrows the arteries, is called atherosclerosis. If these buildups, or plaques, become large enough, they can block the blood vessel.

Blocking blood flow to your heart causes a heart attack. Every year in the U.S., more than 800,000 people have a heart attack, according to the Centers for Disease Control and Prevention (CDC).

Statins and other LDL-lowering drugs slow buildup in blood vessels—and it’s a lifesaving effect. When LDL drops, the risk for heart attack decreases. Taking statins can also significantly reduce the chances of stroke, many of which are caused by blocked blood flow to the brain.

Sticking to your treatment plan

Reducing LDL levels and keeping them down is a lifetime commitment. Medications work faster than changing your eating and exercise habits, but both can be important components to good health. The key is to stick with your treatment plan. When people stop their medications or relapse into unhealthier habits, cholesterol levels will climb again. And with those increasing levels, your risk for stroke, heart attack, and other heart disease climbs, too.

If the benefits of treatment are so clear, why would anyone stop?

People discontinue treatment or struggle with keeping their treatment schedule for many reasons. Some factors are financial or relate to access: getting to the pharmacy, maintaining refills, or affording medication. Others are more personal, such as forgetting to take your medication or discontinuing because you feel worse from side effects. You may also feel better or begin to see improvement in your cholesterol numbers and think you don’t need the drugs anymore. And many prescriptions, such as those used for treating cholesterol, can be complicated to understand and follow.

When people stop taking cholesterol-lowering drugs, they often do so because the side effects—such as muscle pain—bother them too much. High cholesterol often causes no symptoms but instead relentlessly and silently promotes disease. So, people taking medications don’t always see the benefits and instead feel only the negatives over the short term.

If you find that you don’t want to take your medication because of side effects, talk to your HCP. There are many options for cholesterol-lowering drugs, including several statins and other classes of medication. Each of them carries its own side-effect profile. Talk to your HCP about what is best for you and be sure to follow your treatment plan as directed.