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Risk for Coronary Heart Disease (CHD) & Cholesterol Classifications


CHD Risk and Diabetes Mellitus

People with diabetes are at greater risk for developing coronary heart disease. Factors other than diabetes which raise the risk for CHD include:

Type 2 diabetes, besides operating as an independent risk factor for coronary heart disease (CHD), is frequently accompanied by high LDL cholesterol, low HDL cholesterol, and elevated triglycerides. Elevated LDL cholesterol and reduced HDL cholesterol increase the risk for developing CHD. Whatever the cholesterol levels though (or the level of other CHD risk factors), diabetes increases the risk of CHD twofold to fivefold.

It is recommended that everyone, especially those with diabetes, have their blood lipid levels measured regularly, adults 20 years of age and older at least once every 5 years.


Cholesterol Classifications

The following lipid classifications were presented in the Third Report of the National Cholesterol Education Program (NCEP)*.

-- Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). 2001;285(19):2486-2497.

Total Cholesterol

Cholesterol Level Classification
< 200 mg/dl Desirable blood cholesterol
200-239 mg/dl Borderline high blood cholesterol
>/= 240 mg/dl High blood cholesterol

HDL Cholesterol

Cholesterol Level Classification
< 40 mg/dl Low HDL cholesterol
> 60 mg/dl High HDL cholesterol (desirable)

LDL Cholesterol

Cholesterol Level Classification
< 100 mg/dl Optimal (Recommended for people with CHD or diabetes.)
< 130 mg/dl Desirable
100-129 mg/dl Near or above optimal
130-159 mg/dl Borderline high
160-189 mg/dl High
> 190 mg/dl Very high

Elevated levels of triglycerides (TGs) are also a risk factor for CHD, and often accompany a diagnosis of type 2 diabetes. The NCEP's Third Report makes the following classifications:

Triglycerides

Triglyceride Level Classification
< 150 mg/dl Normal triglycerides
150-199 mg/dl Borderline-high triglycerides
200-499 mg/dl High triglycerides
> 500 mg/dl Very high triglycerides

Total cholesterol levels don't tell the whole story. A high LDL cholesterol level will increase your CHD risk, but a low HDL cholesterol level will also increase CHD risk. A good way to gauge your risk is to consider your cholesterol ratios:

Total cholesterol/HDL-C is best below 4.
LDL-C/HDL-C is best below 3.

Your healthcare provider will select treatment based on your CHD risk factors and your lipid profile. Individuals with desirable cholesterol levels do not need active medical therapy for blood lipids, but should obtain information on diet and exercise and be evaluated in 5 years. Patients at high risk may warrant drug therapy in addition to diet modification and exercise therapy. Those at lower risk can be treated with diet and exercise alone.


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