How do you and your doctor decide whether and how to treat your cholesterol? Even though high cholesterol is clearly linked to heart disease, you shouldn’t make the decision about treatment based solely on your cholesterol numbers. I know, this sounds counterintuitive, but the point of treating high cholesterol is to prevent heart disease.

And other risk factors besides cholesterol come into play when determining your risk of heart disease. So two people with the same cholesterol levels may walk out of their doctors’ office with completely different advice: one may be told to fill a prescription for a cholesterol-lowering drug; the other may be told to get more exercise and eat better.

Similarly, if you need treatment, its intensity should be based on your individual risk status. Preventing heart disease is definitely not a “one-size-fits-all” process—the higher your risk, the more aggressive your treatment, and vice versa.

The National Cholesterol Education Program (NCEP) made this task of tailoring a treatment program to each individual’s needs a little easier by publishing guidelines. These guidelines, updated most recently in 2004, base treatment on a person’s risk factors and the likelihood that he or she will develop heart disease in the next ten years.

This next is outlines the NCEP guidelines, which most other doctors use to make decisions about treatment. Your doctor may not go through each step with you explicitly, but ask him or her about the decision-making process and you’re likely to hear something similar to what follows.

You can also use the following information on your own to figure out your risk levels and what you can do to reduce your risk. But of course, you can’t measure your lipid profile without help, and an overall assessment of the risks and benefits of drug treatment for anybody really requires a thoughtful conversation with a medical professional who can then prescribe the appropriate medications, if needed.

1. Considering Your Cholesterol Levels. Once you have your cholesterol results back, you can compare them to what the NCEP guidelines consider to be favorable levels.

2. Determining if You Have Heart Disease or Diabetes. People who have heart disease have a much greater chance of having a heart attack than those who don’t. In fact, more than twenty out of every one hundred people with heart disease will have recurrent heart disease within ten years.

3. Measuring Your Risk Factors. There are a lot of risk factors that increase your chance of having a heart attack. Count your major risk factors, which include these:

• Cigarette smoking
• High blood pressure (greater than 140/90 mm Hg or treated with a blood pressure medication)
• Family history of early heart disease (at younger than fiftyfive in male first-degree relatives and sixty-five in female first-degree relatives)
• Aged over forty-five in men and fifty-five in women

4. Calculating Your Heart Attack Risk. Use worksheet from NCEP guidelines, that's will help people who have two or more major risk factors determine their risk of having a heart attack in the next ten years. You can use it to add up your points and then determine your risk level.

5. Finding Your Treatment Category. Armed with your responses from Steps 1 through 4, use the following information to figure out which treatment category you fit into.* In addition, you can determine what your LDL goal should be.

6. Determining Your Treatment. Based on the previous information, you are able to determine three things:

• The LDL level you should strive for
• The LDL level that should compel you to change your lifestyle
• The LDL level at which you should consider going on drug therapy

Guidelines are not rules for everyone. If you and your doctor note that you have a lot of secondary risk factors that the NCEP guide lines don’t take into account, you may decide to treat your high cholesterol more aggressively than the NCEP guidelines indicate.

Or if you have a lot of lifestyle risk factors that you are willing and able to change, maybe you and your doctor will want to assess your cholesterol levels again after a few months of your new habits before you try a cholesterol-lowering drug. It’s also important to keep in mind that the NCEP guidelines exist in a bit of a vacuum.

They’re updated every few years to include major breakthroughs, but in the years between updates, the already-published guidelines can’t take into account studies that come out. And of course, a doctor’s experience with an individual patient or a subgroup of patients may tell him or her that there’s a better way to handle your case.