{ "release_id": "f4600233112e1c27", "id": "cardio:guide-cholesterol-numbers-and-medicines", "owner": "cardio", "kind": "patient_guide", "slug": "cholesterol-numbers-and-medicines", "name": "Cholesterol numbers and medicines explained", "aliases": [], "atlases": [ "cardio" ], "summary_plain": "What LDL and Lp(a) are, the levels that MedlinePlus and the abstract of a 2018 guideline that a 2026 guideline replaces name, and where statins and other cholesterol medicines fit. It does not read anyone's own result.", "summary_technical": "A static explainer written from public MedlinePlus pages, two NHLBI pages, three PubMed abstracts, two drug labels and one company press release. Every sentence cites a source, and the guide gives no advice for one reader.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": "2026-10-15", "next_review_due": "2027-04-15", "identifiers": [], "navigation": { "cardio": { "condition-area": [ "coronary-and-vascular-disease", "risk-and-prevention" ], "system": [ "metabolism" ] } }, "payload": { "purpose": "explainer", "audience": "Adults who want to understand cholesterol numbers and medicines, and the people with them", "about": [ "cardio:ldl-cholesterol", "cardio:high-ldl-cholesterol", "cardio:lipoprotein-a", "cardio:statins", "cardio:ezetimibe", "cardio:pcsk9", "cardio:repatha", "cardio:evolocumab", "cardio:leqvio", "cardio:inclisiran" ], "reading_grade_target": 10, "scope_note": "Written from US government health pages, the PubMed abstracts of two guidelines and one consensus statement, a company press release and two drug labels. For the 2026 guideline it read only the abstract, which gives none of the levels in this guide. PubMed lists two corrections to the 2018 guideline, and it did not read them. It describes what these sources say. It gives no advice for one person.", "warning_blocks": [], "sections": [ { "heading": "What LDL and Lp(a) are", "statements": [ { "id": "ld-1", "text": "LDL and HDL are two types of lipoproteins, which combine fat and protein so the fat can move through the blood.", "cites": [ { "snapshot_id": "cardio:medlineplus-ldlthebadcholesterol-2026-10-14", "locator": "Summary, What are LDL and HDL?" } ] }, { "id": "ld-2", "text": "LDL is sometimes called bad cholesterol because a high LDL level leads to a buildup of cholesterol in the arteries.", "cites": [ { "snapshot_id": "cardio:medlineplus-ldlthebadcholesterol-2026-10-14", "locator": "Summary, What are LDL and HDL?" } ] }, { "id": "ld-3", "text": "According to MedlinePlus, extra LDL forms plaque in the arteries, and plaque buildup in the arteries of the heart is coronary artery disease.", "cites": [ { "claim": "cardio:claim-high-ldl-raises-cad-risk" } ] }, { "id": "lp-1", "text": "MedlinePlus describes lipoprotein (a), written Lp(a), as a type of LDL.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "What is a lipoprotein (a) blood test?" } ] }, { "id": "lp-2", "text": "It says Lp(a) particles are stickier than other LDL particles, so they may be more likely to cause blockages and blood clots in the arteries.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "What is a lipoprotein (a) blood test?" } ] }, { "id": "lp-3", "text": "Genes control how much Lp(a) a person makes, and NHLBI says the level is unlikely to shift much over a lifetime.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "Is there anything else I need to know about a lipoprotein (a) test?" }, { "snapshot_id": "cardio:nhlbi-blood-cholesterol-diagnosis-2026-10-15", "locator": "Lipoprotein-a" } ] }, { "id": "lp-5", "text": "MedlinePlus also says diet and exercise may not change Lp(a) levels.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "Is there anything else I need to know about a lipoprotein (a) test?" } ] }, { "id": "lp-6", "text": "MedlinePlus says a routine cholesterol test can show a healthy-looking LDL level.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "What is a lipoprotein (a) blood test?" } ] }, { "id": "lp-6b", "text": "It says the risk could still be high if Lp(a) carries a large share of the LDL.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "What is a lipoprotein (a) blood test?" } ] } ] }, { "heading": "The numbers on a cholesterol test", "statements": [ { "id": "t-1", "text": "A cholesterol test, also known as a lipid panel, is a blood test that measures cholesterol and triglycerides, a type of fat.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterol-levels-2026-10-15", "locator": "What is a cholesterol test?" } ] }, { "id": "t-2", "text": "Cholesterol is usually measured in milligrams of cholesterol per deciliter of blood, written mg/dL.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterol-levels-2026-10-15", "locator": "What do the results mean?" } ] }, { "id": "t-3", "text": "The LDL on a report may be calculated, an estimate from total cholesterol, HDL and triglycerides, or measured directly from the blood sample.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterol-levels-2026-10-15", "locator": "What do the results mean?" } ] }, { "id": "t-4", "text": "For adults aged 20 or older, MedlinePlus lists an LDL of less than 100 mg/dL as a healthy level.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterol-levels-2026-10-15", "locator": "What do the results mean?" } ] }, { "id": "t-5", "text": "MedlinePlus says a healthy level may depend on age, family history, lifestyle and other risk factors.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterol-levels-2026-10-15", "locator": "What do the results mean?" } ] }, { "id": "t-5b", "text": "It says a provider can explain what is right for the person.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterol-levels-2026-10-15", "locator": "What do the results mean?" } ] } ] }, { "heading": "Levels named for starting medicines", "statements": [ { "id": "mp-0", "text": "MedlinePlus lists four situations in which a health care provider may prescribe cholesterol medicines.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterolmedicines-2026-10-15", "locator": "Who needs cholesterol medicines?" } ] }, { "id": "mp-1", "text": "One is a past heart attack, a past stroke, or peripheral arterial disease.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterolmedicines-2026-10-15", "locator": "Who needs cholesterol medicines?" } ] }, { "id": "mp-2", "text": "Another is an LDL cholesterol level of 190 mg/dL or higher.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterolmedicines-2026-10-15", "locator": "Who needs cholesterol medicines?" } ] }, { "id": "mp-3", "text": "Another is the combination of an age of 40 to 75, diabetes, and an LDL level of 70 mg/dL or higher.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterolmedicines-2026-10-15", "locator": "Who needs cholesterol medicines?" } ] }, { "id": "mp-4", "text": "The last is the combination of an age of 40 to 75, a high risk of heart disease or stroke, and an LDL level of 70 mg/dL or higher.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterolmedicines-2026-10-15", "locator": "Who needs cholesterol medicines?" } ] } ] }, { "heading": "Levels in the 2018 AHA/ACC guideline (since replaced)", "statements": [ { "id": "gl-9", "text": "The 2026 ACC/AHA guideline on dyslipidemia retires and replaces the 2018 AHA/ACC guideline on managing blood cholesterol.", "cites": [ { "claim": "cardio:claim-acc-aha-2026-dyslipidemia-replaces-2018" } ] }, { "id": "gl-0", "text": "The abstract of the 2026 guideline names none of the levels below, so they come from the 2018 abstract.", "cites": [ { "snapshot_id": "cardio:pubmed-41824552-2026-10-15", "locator": "Abstract, STRUCTURE" }, { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 8" } ] }, { "id": "gl-0b", "text": "PubMed lists two corrections to the 2018 guideline, from 2019 and 2023, with no text that shows whether they change these levels.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "CommentsCorrectionsList, two ErratumIn entries" } ] }, { "id": "gl-1", "text": "The 2018 abstract named adults who are 40 to 75 years old, have no diabetes, and whose estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) is 7.5% to 19.9%, which it called intermediate risk.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 8" } ] }, { "id": "gl-1b", "text": "For them, it said risk-enhancing factors favor starting a statin.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 8" } ] }, { "id": "gl-2", "text": "It listed a persistently elevated LDL of 160 mg/dL or higher as one of those factors.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 8" } ] }, { "id": "gl-3", "text": "It also listed a lipoprotein (a) level of at least 125 nmol/L or 50 mg/dL, if measured in selected people, especially at higher values.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 8" } ] }, { "id": "gl-4", "text": "For people with atherosclerotic cardiovascular disease at very high risk, it set 70 mg/dL of LDL as the level to consider adding a nonstatin medicine to a statin.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 3" } ] }, { "id": "gl-5", "text": "It defined very high risk as a history of several major events, or one major event plus several high-risk conditions.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 3" } ] }, { "id": "gl-6", "text": "In that group it called adding ezetimibe reasonable when LDL stayed at 70 mg/dL or higher on the most statin a person could take.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 3" } ] }, { "id": "gl-7", "text": "If LDL still stayed at 70 mg/dL or higher on that statin plus ezetimibe, it called adding a PCSK9 inhibitor reasonable.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 3" } ] }, { "id": "gl-8", "text": "It noted that long-term safety beyond 3 years was uncertain and that, at the list prices of mid-2018, cost-effectiveness was low.", "cites": [ { "snapshot_id": "cardio:pubmed-30586774-2026-10-15", "locator": "Abstract, recommendation 3" } ] } ] }, { "heading": "Testing for Lp(a)", "statements": [ { "id": "lp-7", "text": "MedlinePlus says a test for Lp(a) is not a routine screening test.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "What is it used for?" } ] }, { "id": "lp-7b", "text": "It says the test is usually ordered if a provider thinks a person might be at high risk of heart problems, or if high Lp(a) runs in the family.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "What is it used for?" } ] }, { "id": "lp-8", "text": "MedlinePlus adds that researchers are still studying how Lp(a) levels affect health and when the test should be used.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "What is it used for?" } ] }, { "id": "lp-9", "text": "MedlinePlus lists situations, such as those in the checklist below, in which a provider may order a test for Lp(a).", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "Why do I need a lipoprotein (a) test?" } ] }, { "id": "eas-1", "text": "In 2022, the European Atherosclerosis Society published a consensus statement that recommended adults have Lp(a) measured at least once.", "cites": [ { "snapshot_id": "cardio:pubmed-36036785-2026-10-15", "locator": "Abstract" } ] }, { "id": "eas-2", "text": "Without therapies that specifically lower Lp(a), the panel recommended early, intensive management of risk factors.", "cites": [ { "snapshot_id": "cardio:pubmed-36036785-2026-10-15", "locator": "Abstract" } ] }, { "id": "eas-3", "text": "The panel said this management is targeted by overall cardiovascular risk and the Lp(a) level.", "cites": [ { "snapshot_id": "cardio:pubmed-36036785-2026-10-15", "locator": "Abstract" } ] }, { "id": "nh-1", "text": "NHLBI says that for a person with a high Lp(a) level, a provider may prescribe statins to help lower heart disease risk, even when the other cholesterol numbers are healthy.", "cites": [ { "snapshot_id": "cardio:nhlbi-blood-cholesterol-diagnosis-2026-10-15", "locator": "Lipoprotein-a" } ] }, { "id": "np-1", "text": "On 4 September 2026, Novartis reported that a phase 3 trial of pelacarsen, a medicine that lowers Lp(a), missed its main goal.", "cites": [ { "claim": "cardio:claim-lpa-horizon-pelacarsen-topline-null" } ] }, { "id": "np-1b", "text": "The trial compared pelacarsen with placebo in adults with elevated Lp(a) and established cardiovascular disease.", "cites": [ { "claim": "cardio:claim-lpa-horizon-pelacarsen-topline-null" } ] }, { "id": "np-2", "text": "The press release gave no numbers and said full results would be shown at a future scientific meeting, so the result may be refined.", "cites": [ { "claim": "cardio:claim-lpa-horizon-pelacarsen-topline-null" } ] } ] }, { "heading": "Where statins and other medicines fit", "statements": [ { "id": "st-1", "text": "MedlinePlus calls statins the most commonly used medicines for high cholesterol.", "cites": [ { "snapshot_id": "cardio:medlineplus-statins-2026-10-14", "locator": "Summary, What are statins?" } ] }, { "id": "st-2", "text": "MedlinePlus says statins slow how much cholesterol the liver makes.", "cites": [ { "snapshot_id": "cardio:medlineplus-statins-2026-10-14", "locator": "Summary, How do statins lower cholesterol?" } ] }, { "id": "st-2b", "text": "It says they also increase the liver's ability to remove LDL already in the blood.", "cites": [ { "snapshot_id": "cardio:medlineplus-statins-2026-10-14", "locator": "Summary, How do statins lower cholesterol?" } ] }, { "id": "st-3", "text": "MedlinePlus says a provider may prescribe a statin when lifestyle changes fail to lower high cholesterol enough.", "cites": [ { "snapshot_id": "cardio:medlineplus-statins-2026-10-14", "locator": "Summary, What are statins?" } ] }, { "id": "st-4", "text": "MedlinePlus says studies show statins reduce the chance of a heart attack or a stroke for people whose LDL cholesterol is high.", "cites": [ { "snapshot_id": "cardio:medlineplus-statins-2026-10-14", "locator": "Summary, How do statins lower cholesterol?" } ] }, { "id": "st-5", "text": "MedlinePlus says statins usually cause no side effects but may increase type 2 diabetes risk, mostly for people who are already at high risk for it.", "cites": [ { "snapshot_id": "cardio:medlineplus-statins-2026-10-14", "locator": "Summary, What are the risks of taking statins?" } ] }, { "id": "st-6", "text": "It adds that statins may cause abnormal liver enzyme test results, but that actual liver damage is very rare.", "cites": [ { "snapshot_id": "cardio:medlineplus-statins-2026-10-14", "locator": "Summary, What are the risks of taking statins?" } ] }, { "id": "st-7", "text": "It calls muscle damage an uncommon side effect that can, in rare cases, lead to muscle pain and kidney damage.", "cites": [ { "snapshot_id": "cardio:medlineplus-statins-2026-10-14", "locator": "Summary, What are the risks of taking statins?" } ] }, { "id": "ot-2", "text": "MedlinePlus says cholesterol absorption inhibitors are used when statins cannot be taken or do not lower cholesterol enough on their own.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterolmedicines-2026-10-15", "locator": "What are the different types of cholesterol medicines?" } ] }, { "id": "ot-3", "text": "NHLBI says a provider may use ezetimibe when statins produce side effects or when a statin and lifestyle changes fail to bring LDL down enough.", "cites": [ { "snapshot_id": "cardio:nhlbi-blood-cholesterol-treatment-2026-10-15", "locator": "Medicines" } ] }, { "id": "pc-1", "text": "PCSK9 inhibitors block a protein called PCSK9, and MedlinePlus says this helps the liver remove LDL from the blood.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterolmedicines-2026-10-15", "locator": "What are the different types of cholesterol medicines?" } ] }, { "id": "pc-2", "text": "MedlinePlus says a provider may prescribe both a statin and a PCSK9 inhibitor for people who have familial hypercholesterolemia.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterolmedicines-2026-10-15", "locator": "What are the different types of cholesterol medicines?" } ] }, { "id": "pc-2b", "text": "It names people with a high risk of complications such as heart attack or stroke as another group.", "cites": [ { "snapshot_id": "cardio:medlineplus-cholesterolmedicines-2026-10-15", "locator": "What are the different types of cholesterol medicines?" } ] } ] }, { "heading": "Who two medicines are labeled for, as of October 2026", "statements": [ { "id": "rp-1", "text": "The label for Repatha (evolocumab) lists use to lower the risk of major adverse cardiovascular events in adults at increased risk of them.", "cites": [ { "snapshot_id": "cardio:openfda-label-cd61e902-166d-4aa6-9f3c-a18c1008d07e-2026-10-14", "locator": "results[0].indications_and_usage[0]" }, { "claim": "cardio:claim-fda-repatha-bla125522-approval" } ] }, { "id": "rp-2", "text": "The Repatha label also lists use, as an adjunct to diet and exercise, to reduce LDL cholesterol in adults with hypercholesterolemia.", "cites": [ { "snapshot_id": "cardio:openfda-label-cd61e902-166d-4aa6-9f3c-a18c1008d07e-2026-10-14", "locator": "results[0].indications_and_usage[0]" } ] }, { "id": "rp-3", "text": "It lists that use in adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia.", "cites": [ { "snapshot_id": "cardio:openfda-label-cd61e902-166d-4aa6-9f3c-a18c1008d07e-2026-10-14", "locator": "results[0].indications_and_usage[0]" } ] }, { "id": "rp-4", "text": "It also lists that use in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia.", "cites": [ { "snapshot_id": "cardio:openfda-label-cd61e902-166d-4aa6-9f3c-a18c1008d07e-2026-10-14", "locator": "results[0].indications_and_usage[0]" } ] }, { "id": "lq-1", "text": "The label for Leqvio (inclisiran) lists use, as an adjunct to diet and exercise, to reduce LDL cholesterol in adults with hypercholesterolemia.", "cites": [ { "snapshot_id": "cardio:openfda-label-6fc0afca-4513-4c35-b594-6544aee29a44-2026-10-14", "locator": "results[0].indications_and_usage[0]" }, { "claim": "cardio:claim-fda-leqvio-nda214012-approval" } ] }, { "id": "lq-2", "text": "The Leqvio label also lists that use in adults and pediatric patients aged 12 years and older with heterozygous familial hypercholesterolemia.", "cites": [ { "snapshot_id": "cardio:openfda-label-6fc0afca-4513-4c35-b594-6544aee29a44-2026-10-14", "locator": "results[0].indications_and_usage[0]" } ] }, { "id": "lq-3", "text": "It lists that use in pediatric patients aged 12 years and older with homozygous familial hypercholesterolemia.", "cites": [ { "snapshot_id": "cardio:openfda-label-6fc0afca-4513-4c35-b594-6544aee29a44-2026-10-14", "locator": "results[0].indications_and_usage[0]" } ] } ] } ], "checklists": [ { "heading": "Situations MedlinePlus lists for an Lp(a) test", "items": [ { "id": "z-1", "text": "A father or brother with early heart or blood vessel disease (before age 55), or a mother or sister (before age 65).", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "Why do I need a lipoprotein (a) test?" } ] }, { "id": "z-2", "text": "High LDL cholesterol even though the person takes medicine to lower it.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "Why do I need a lipoprotein (a) test?" } ] }, { "id": "z-3", "text": "Heart or blood vessel disease, especially when cholesterol and triglyceride levels are normal without medicine to lower them.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "Why do I need a lipoprotein (a) test?" } ] }, { "id": "z-4", "text": "Signs of familial hypercholesterolemia, an inherited condition that causes high cholesterol levels.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "Why do I need a lipoprotein (a) test?" } ] }, { "id": "z-5", "text": "More than one heart attack, or more than one angioplasty, a procedure to open narrow or blocked arteries in the heart.", "cites": [ { "snapshot_id": "cardio:medlineplus-lipoprotein-a-blood-test-2026-10-15", "locator": "Why do I need a lipoprotein (a) test?" } ] } ] } ], "questions": [ { "text": "Which LDL levels in these sources, if any, apply to my age and health history?", "grounded_in": [ "mp-1", "mp-2", "mp-3", "mp-4", "gl-1", "gl-2" ] }, { "text": "Which levels does my clinician use now, since the 2026 guideline replaced the 2018 one?", "grounded_in": [ "gl-9", "gl-1", "gl-4" ] }, { "text": "Was my LDL calculated or measured directly, and does that matter for me?", "grounded_in": [ "t-3" ] }, { "text": "What do my cholesterol numbers mean, given my age, family history and other risk factors?", "grounded_in": [ "t-4", "t-5" ] }, { "text": "Has my Lp(a) ever been measured, and would a test make sense given my family history?", "grounded_in": [ "lp-7", "lp-7b", "lp-9", "z-1", "eas-1" ] }, { "text": "If my Lp(a) is high, what can be done to lower my overall risk?", "grounded_in": [ "eas-2", "eas-3", "nh-1", "lp-5" ] }, { "text": "If my LDL stays high on a statin, which other medicines could help, and what are their benefits and side effects?", "grounded_in": [ "gl-6", "gl-7", "ot-2", "ot-3", "pc-2" ] }, { "text": "What side effects of a statin are possible, and how would they be checked?", "grounded_in": [ "st-5", "st-6", "st-7" ] }, { "text": "Is a medicine I am offered labeled for someone of my age and with my condition?", "grounded_in": [ "rp-1", "rp-2", "rp-3", "rp-4", "lq-1", "lq-2", "lq-3" ] } ] }, "content_digest": "328ca6027a1ece6bbc5ba45b0419da4301148d4d0471c51ccc1fc16c3178af06", "review": { "content_digest": 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