5 Things to Know When Managing Your Cholesterol, with Michael Davidson, M.D.

With decades of experience as a practicing lipidologist, Michael Davidson, M.D., who now serves as the CEO of NewAmsterdam Pharma and director of the Lipid Clinic at the University of Chicago, shares critical insights on cholesterol management and cardiovascular risk. He emphasizes that proactive cholesterol management can significantly reduce heart disease risk and that early intervention is key.

Davidson emphasizes the importance of low-density lipoprotein (LDL) cholesterol as the primary factor in cardiovascular disease. He explains that LDL cholesterol is the most significant component of total cholesterol and is directly linked to plaque buildup and heart disease risk.

Assessing cardiovascular risk involves evaluating existing conditions, including previous heart attacks, strokes or coronary artery disease. Advancements in imaging, such as coronary calcium scoring, allow for earlier detection of plaque, particularly in individuals over 40 (men) and 50 (women). If calcium scores indicate significant plaque buildup, patients should adopt a more aggressive cholesterol management strategy.

Davidson outlines LDL treatment goals based on risk levels: those with established heart disease should aim for LDL levels below 70 milligrams per deciliter (mg/dL), while individuals at higher risk may need to lower it further to 55 mg/dL. For those without known heart disease or plaque buildup, maintaining LDL below 100 mg/dL is generally sufficient.

Primary prevention efforts focus on identifying and treating high LDL levels early, particularly in cases of familial hypercholesterolemia, a genetic condition requiring treatment even in childhood. He also highlights the emerging concept of “primordial prevention,” which promotes treating high cholesterol earlier in life (ages 20-50) rather than waiting for plaque development. This approach is based on research showing that early intervention prevents long-term cardiovascular complications more effectively than late-stage treatment.

Davidson emphasizes that keeping lifetime cholesterol exposure below 8 grams can significantly reduce heart disease risk. He explains that LDL levels naturally start low in early adulthood and rise over time, so maintaining LDL below 80 mg/dL from a young age is key to long-term cardiovascular health.

He stresses that delaying LDL treatment is akin to waiting for a stroke to treat high blood pressure or waiting for organ damage to treat diabetes. Instead, he advocates for a shift in thinking — lowering LDL early and sustaining treatment long-term to prevent cardiovascular events before they occur.

5 Things to Know When Managing Your Cholesterol

• Understanding LDL cholesterol: The most important cholesterol measurement is LDL cholesterol, as it plays a crucial role in the development of cardiovascular disease.
• Assessing heart disease risk: Knowing your overall risk for heart disease is essential. The main risk factors include a history of heart attack, stroke or known coronary artery blockages.
• Setting LDL cholesterol goals: If heart disease is already present, the goal is to keep LDL below 70 mg/dL, or as low as 55 mg/dL for higher-risk individuals. If no heart disease or plaque is detected, the target LDL is below 100 mg/dL.
• Primary prevention: Even for those without heart disease, primary prevention is crucial.
• Primordial prevention: Emerging research suggests that starting LDL treatment early in life (ages 20-50) provides greater long-term benefits than beginning later in life (ages 50-80).

Davidson stresses that just like hypertension and diabetes, cholesterol should be managed before complications arise, not after a cardiovascular event occurs. The guiding principle: Lower LDL and treat longer for better outcomes.

Editor’s note: This is created for the purposes of education and is not medical advice.