Cholesterol: The lower the better?

When it comes to cholesterol, is lower better? According to Dr. Stephen Fort, Staff Cardiologist and Director of the Cardiac Catheterization Laboratory at Queen Elizabeth II Health Sciences Centre and Associate Professor of Medicine at Dalhousie University, we have evidence that the more aggressively we treat cholesterol, the better the results.

According to recent data, it may even be possible to reverse some of the damage done to the blood vessels if cholesterol is treated aggressively – for example, trying to significantly lower LDL or "bad" cholesterol and increase HDL or "good" cholesterol. We don't currently know whether there is a lower limit to cholesterol lowering. In other words, we don't know if it's possible to go too low, to reduce cholesterol to the point where the risks of lowering cholesterol outweigh the benefits.

How low should your cholesterol be? Dr. Fort says that the target levels you should aim for depend on your risk level. Some people are at higher risk of blood vessel damage from high cholesterol, and the serious complications that go with it (to learn more, see "How high cholesterol affects your blood vessels"). These include people with higher levels of cholesterol, smokers, people with diabetes, people with high blood pressure, and those with a family history of heart disease.

In general, the higher your risk, the more your cholesterol needs to be lowered, and the lower the targets you should be aiming for. In fact, for people at high risk, lowering cholesterol may be beneficial even if their cholesterol is in the "normal range."

The first step in figuring out your cholesterol targets is to see your doctor. Your doctor will ask you questions about your health and your family history, do some medical tests (such as measuring your cholesterol levels and blood pressure), and use this information to determine your risk level. Based on your risk level, your doctor will let you know what your cholesterol target levels should be. To learn more about your risk of heart disease, see our Heart Disease Risk Calculator.

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