LDL threshold for starting statins in otherwise healthy patients

What is the threshold for low-density lipoprotein (LDL) cholesterol levels for starting statins in otherwise healthy middle-aged men or women?

Ian Graham: This depends on the level of risk. The decision is based on the level of risk, for example, from the Systematic Coronary Risk Evaluation (SCORE) risk chart, and the level of LDL cholesterol, and both are taken into account in making the decision. It is graduated according to the level of risk and the height, or the level, of the LDL cholesterol. There is a table that spells this out with 3 major options. For example, lifestyle advice is recommended for everybody and lifestyle advice alone is recommended, for example, if the LDL cholesterol is below 70 mg/dL, or 1.8 mmol/L, and the SCORE risk is 1% to 5%.

The next step is to consider drug treatment if the LDL is uncontrolled, for example, an LDL of under 100 or 155 mg/dL, that is between 2.6 and 4 mmol/L, and a SCORE of [1% to 5%]. One would then consider drug treatment if the LDL remains somewhat elevated.

Then there is a group of high-risk people in whom drug intervention is clearly indicated. For example, somebody with an LDL between 155 and 190 mg/dL, that is between 4 and 4.9 mmol/L, and a SCORE of over 5%. There is a table that explains these thresholds very clearly in the guidelines.