Step 4 If 2+ risk factors (other than LDL)are present without CHD or CHD risk equivalent, assess 10-year(short-term) CHD risk(see Framingham tables) Three levels of 10-year risk: 20%-CHd risk equivalent 10-20% < step 5 Determine risk category Establish LDL goal of therapy Determine need for therapeutic lifestyle changes(TL.C) Determine level for drug consideration LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories. LDL Level at which to Initiate Therapeutic LDL Level at Which to LDL Goal Lifestyle Changes(TLC) Consider Drug Therapy CHD or CHD Risk Equivalents <100 mg/dL (10-year risk >20%) (100-129 mg/dL: drug optional) 10-year risk 10-20% 2+ Risk Factors ≥130mg/dl ≥130mg/dL (160-189 mg/dL: LDL-lowering drug optional) Some authorities recommend use of LDL-lowering drugs in this category if an LDL cholesterol <100 mg/dL cannot be achieved by apeutic lifestyle changes. Others prefer use of drugs that primarily modify triglycerides and HDL e.g., nicotinic acid or fibrate Clinical judgment also may call for ing drug therapy in this subcategory f Almost all people with 0-1 risk factor have a 10-year risk <10%, thus 10-year risk assessment in people with 0-1 risk factor is not necessary. Sten s Initiate therapeutic lifestyle changes (TLC)if LDL is above goal. TLC Features TLC Diet: Saturated fat <7% of calories, cholesterol <200 mg/day Consider increased viscous(soluble)fiber(10-25 g/day) and plant stanols/sterols (2g/day)as therapeutic options to enhance LDl lowering Weight management