Advanced lipid management and cardiovascular risk reduction by board-certified FACC cardiologists at Cross County Cardiology — 5 NJ locations, same-week appointments.

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Understanding High Cholesterol

Cholesterol is a waxy, fat-like substance essential for cell membrane integrity, hormone production, and vitamin D synthesis. When LDL cholesterol (“bad” cholesterol) levels are elevated, it deposits within arterial walls and initiates the atherosclerotic process that drives coronary artery disease, stroke, and peripheral arterial disease. High cholesterol (hypercholesterolemia or hyperlipidemia) is one of the most modifiable cardiovascular risk factors — and one of the most undertreated.

Approximately 93 million American adults have total cholesterol above 200 mg/dL, yet only a fraction receive adequate treatment to reduce their cardiovascular risk.

Key Cholesterol Numbers and Target Goals

• LDL Cholesterol (Low-Density Lipoprotein) — Primary treatment target. Optimal: <100 mg/dL; High-risk patients: <70 mg/dL; Very high-risk/established ASCVD: <55–70 mg/dL
• HDL Cholesterol (High-Density Lipoprotein) — “Good” cholesterol. Higher is better. Men: ≥40 mg/dL; Women: ≥50 mg/dL
• Triglycerides — Elevated triglycerides (>150 mg/dL) are an independent cardiovascular risk factor, particularly in patients with metabolic syndrome or diabetes
• Non-HDL Cholesterol — Total cholesterol minus HDL. Includes all atherogenic lipoproteins. Goal: ≤30 mg/dL above LDL target
• Apolipoprotein B (ApoB) — Increasingly recognized as the most direct measure of atherogenic particle burden. Goal for high-risk patients: <80 mg/dL

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Cholesterol Treatment Options

Therapeutic Lifestyle Changes (TLC) — Diet modification (reducing saturated fat, trans fats, and dietary cholesterol; increasing soluble fiber, plant sterols, and omega-3 fatty acids), regular aerobic exercise, and weight management can reduce LDL cholesterol by 10–20%.

Statin Therapy — Statins are the most evidence-based cholesterol-lowering medications, reducing LDL by 30–55% depending on dose and type. Beyond LDL lowering, statins stabilize arterial plaque and reduce inflammation. We prescribe high-intensity statins (rosuvastatin, atorvastatin) for high-risk patients and titrate to achieve guideline-based LDL targets.

Ezetimibe — Reduces intestinal cholesterol absorption by ~18–25%. Used in combination with statins when LDL targets are not met on statin therapy alone.

PCSK9 Inhibitors (evolocumab, alirocumab) — Injectable medications administered every 2–4 weeks that reduce LDL by 50–65% beyond maximally tolerated statin therapy. Indicated for very high-risk patients, familial hypercholesterolemia, and statin-intolerant patients who cannot reach LDL targets.

Bempedoic Acid — An oral non-statin agent that reduces LDL by ~18% and reduces cardiovascular events. Particularly useful for statin-intolerant patients.

Inclisiran — A newer RNA interference medication administered twice yearly by injection that reduces LDL by approximately 50%.

Fibrates & Omega-3 Fatty Acids — Used primarily for the treatment of elevated triglycerides (hypertriglyceridemia).

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Familial Hypercholesterolemia (FH)

Familial hypercholesterolemia is an inherited condition causing severely elevated LDL cholesterol (typically above 190 mg/dL) from birth. It significantly accelerates atherosclerosis and dramatically increases premature heart attack risk. Early aggressive treatment is essential. We evaluate patients for possible FH and initiate appropriate high-intensity lipid-lowering therapy.

Why Cross County Cardiology for Cholesterol Management

• Cardiologist-led lipid management — beyond what primary care typically offers
• PCSK9 inhibitor prescribing and prior authorization expertise
• Cardiovascular risk calculation (ASCVD score) and coronary calcium scoring guidance
• Statin intolerance management with alternative regimens
• 5 NJ locations with same-week appointments

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Frequently Asked Questions

What cholesterol level requires medication?

The decision to start cholesterol medication depends on your LDL level and your overall cardiovascular risk — not on a single number alone. High-risk patients (with diabetes, hypertension, smoking, or established heart disease) benefit from statin therapy even at lower LDL levels. Our cardiologists use the ASCVD risk calculator and individual risk factors to make personalized treatment recommendations.

Are statins safe for long-term use?

Yes. Statins are among the most extensively studied medications in medicine, with decades of safety data. Mild muscle aches occur in a minority of patients. Serious muscle damage (rhabdomyolysis) is extremely rare. The benefits of statin therapy in reducing heart attack and stroke far outweigh the risks in appropriate patients.

I can’t tolerate statins. What are my options?

Multiple non-statin and alternative statin options exist. We can try a different statin at a lower dose, switch to every-other-day dosing, or use alternative medications such as ezetimibe, bempedoic acid, or PCSK9 inhibitors. Statin intolerance should not prevent effective cholesterol management.

Can I lower my cholesterol without medication?

Lifestyle changes including diet improvement (reducing saturated fat, increasing soluble fiber), regular aerobic exercise, and weight loss can reduce LDL cholesterol by 10–20%. For patients with significantly elevated LDL or established cardiovascular disease, medication is typically required to achieve guideline-based targets.

How often should I have my cholesterol checked?

Adults 20 and older should have a fasting lipid panel checked at least every 5 years. Patients on lipid-lowering therapy should have follow-up testing 4–12 weeks after starting or changing therapy and then every 3–12 months to assess response and adherence.