High cholesterol — clinically called hyperlipidemia or dyslipidemia — is one of the most common and most treatable risk factors for cardiovascular disease. Elevated low-density lipoprotein (LDL) cholesterol — the 'bad' cholesterol — contributes to the buildup of fatty plaques (atherosclerosis) in arteries, narrowing blood vessels and dramatically increasing the risk of heart attack, stroke, and peripheral artery disease. Like hypertension, high cholesterol produces no symptoms. You cannot feel it, and you have no warning that arteries are narrowing until a cardiac event occurs. This is why regular lipid screening through your annual exam is critical — and why consistent management through your primary care physician saves lives. At Viva Medical Center in Doral, FL, we offer comprehensive cholesterol management for adults throughout Miami-Dade, using the most current evidence-based guidelines and individualized treatment plans that consider your complete cardiovascular risk profile.
Understanding Your Cholesterol Numbers
A standard lipid panel measures four key values:
- Total cholesterol — desirable: less than 200 mg/dL
- LDL cholesterol (low-density lipoprotein) — the primary treatment target; optimal less than 100 mg/dL for most adults; less than 70 mg/dL for high-risk patients; less than 55 mg/dL for very high-risk patients (e.g., established ASCVD plus additional risk factors)
- HDL cholesterol (high-density lipoprotein) — protective 'good' cholesterol; higher is better; men: ideally ≥ 40 mg/dL; women: ideally ≥ 50 mg/dL
- Triglycerides — blood fats elevated by diet, diabetes, and alcohol; normal: less than 150 mg/dL; borderline high: 150–199 mg/dL; high: 200–499 mg/dL; very high: ≥ 500 mg/dL (pancreatitis risk)
Who Needs Cholesterol Treatment?
Treatment decisions are based on your LDL level combined with your overall 10-year cardiovascular risk, not LDL alone:
- High-intensity statin therapy for: established ASCVD (prior heart attack, stroke, stent); LDL ≥ 190 mg/dL (familial hypercholesterolemia); diabetes age 40–75 with LDL 70–189 mg/dL and elevated risk
- Moderate-intensity statin therapy for: elevated cardiovascular risk based on 10-year risk calculator
- Lifestyle modification alone for lower-risk patients with modestly elevated LDL
- All patients regardless of medication status benefit from heart-healthy lifestyle changes
Treatment Options
Our physicians use a stepped approach to cholesterol management, individualized to your risk level and tolerance:
- Statins (atorvastatin, rosuvastatin, simvastatin) — first-line and most extensively studied; reduce LDL by 30–50% (moderate) to 50%+ (high intensity)
- Ezetimibe (Zetia) — adds 15–20% LDL reduction; well-tolerated; used when statins alone are insufficient or when statin dose needs to be limited
- PCSK9 inhibitors (evolocumab/Repatha, alirocumab/Praluent) — injectable; reduce LDL by 50–60% on top of statin; for very high-risk patients or those who cannot tolerate statins
- Bempedoic acid (Nexletol) — oral, non-statin option; useful for statin-intolerant patients
- Icosapentaenoic acid (Vascepa) — omega-3 fatty acid; FDA-approved for cardiovascular risk reduction in high-triglyceride patients on statins
- Lifestyle: heart-healthy diet (Mediterranean pattern), exercise, weight management, smoking cessation
Monitoring at Viva Medical Center
We monitor your lipid panel and response to treatment with the following schedule:
- Baseline lipid panel at initial evaluation
- Repeat lipid panel 4–12 weeks after starting or changing therapy to assess response
- Annual lipid monitoring once stable on treatment
- Liver function tests at baseline and symptom-driven when on statins
- Cardiovascular risk reassessment — incorporating new risk factors and health changes
- Coordination with cardiology for high-risk patients or those requiring PCSK9 inhibitors