Lipid Panel Components
| Component | Role | Desirable Level |
|---|
| LDL (Low-Density Lipoprotein) | "Bad" cholesterol — deposits in artery walls, causes atherosclerosis | Target depends on cardiovascular risk category (see below) |
| HDL (High-Density Lipoprotein) | "Good" cholesterol — removes cholesterol from arteries to liver | >1.0 mmol/L (men); >1.2 mmol/L (women); higher is better |
| Triglycerides | Fat in blood; raised by alcohol, sugar, refined carbs, diabetes | <1.7 mmol/L (fasting) |
| Total Cholesterol | Sum of all cholesterol fractions | <5.0 mmol/L generally |
| Non-HDL Cholesterol | Total minus HDL — all atherogenic particles combined | <4.0 mmol/L (better predictor than LDL alone) |
LDL Targets by Cardiovascular Risk Category
| Risk Category | Definition | LDL Target |
|---|
| Very High Risk | Prior heart attack, stroke, TIA, peripheral arterial disease; OR diabetes with organ damage; OR CKD stage 3–5 | <1.8 mmol/L (<70 mg/dL) and >50% reduction from baseline |
| High Risk | Diabetes without organ damage; markedly elevated single risk factor; moderate CKD | <2.6 mmol/L (<100 mg/dL) |
| Moderate Risk | Young diabetics, 2+ cardiovascular risk factors | <3.0 mmol/L (<115 mg/dL) |
| Low Risk | No significant risk factors | <3.0 mmol/L (<115 mg/dL) |
Statin Therapy
How Statins Work
Statins inhibit HMG-CoA reductase — the rate-limiting enzyme in cholesterol synthesis in the liver. This reduces hepatic cholesterol production, leading the liver to upregulate LDL receptors, which pull more LDL out of the bloodstream. High-intensity statins (rosuvastatin 20–40mg, atorvastatin 40–80mg) reduce LDL by 50%+. Moderate-intensity (atorvastatin 10–20mg, rosuvastatin 5–10mg) reduce LDL by 30–49%.
Muscle Pain Warning (Myopathy)
Muscle aches (myalgia) occur in 5–10% of statin users. Severe muscle breakdown (rhabdomyolysis) is rare (<0.1%). If you develop unexplained severe muscle pain or dark urine, stop the statin and check CK (creatine kinase) urgently. Risk is higher with higher doses and with drug interactions (especially clarithromycin, certain antifungals, cyclosporin). Switching to a different statin often resolves myalgia.
Lifestyle Impact on Cholesterol
| Intervention | Effect on Lipids |
|---|
| Reduce saturated fat (butter, coconut oil, ghee, red meat) | Reduces LDL by 10–20% |
| Eliminate trans fats (partially hydrogenated oils) | Reduces LDL and raises HDL |
| Soluble fibre (oats, psyllium, lentils, apples) | Reduces LDL by 5–10% |
| Plant sterols (fortified margarine/milk, 2g/day) | Reduces LDL by 10–15% |
| Regular aerobic exercise (150+ min/week) | Raises HDL by 5–10%; reduces triglycerides 10–20% |
| Weight loss (per 5 kg) | Reduces triglycerides 20–30%; raises HDL |
| Reduce alcohol | Reduces triglycerides significantly |
| Mediterranean diet pattern | Reduces cardiovascular events independent of LDL |
Monitoring Frequency
- After starting statin: Recheck fasting lipid profile at 6–8 weeks
- Once at target: Annual fasting lipid profile
- Check liver enzymes (ALT) and CK at baseline before starting
- Recheck LFT only if symptoms of liver disease develop
Questions to Ask Your Doctor
- What is my 10-year cardiovascular risk, and which LDL target applies to me?
- What percentage reduction in LDL do I need?
- Which statin and dose do you recommend?
- Can lifestyle changes alone bring my LDL to target, or do I need medication?
- Should I stop the statin if I get muscle aches, or try a different one?
Medical Disclaimer: This information is for educational purposes only. Cholesterol management decisions, including statin therapy, should be made with a qualified doctor based on your individual cardiovascular risk profile.