Clinical Toolkit

  • Having high blood cholesterol raises the risk for heart disease, the leading cause of death, and for stroke, the fifth leading cause of death.

Clinical Toolkit Introduction

Welcome to the IMPACT Clinical Toolkit, a resource center for clinicians who diagnose and/or manage patients with, or who are at risk for developing, hypercholesterolemia. This toolkit provides links with information about pathophysiology, current treatment options, and additional resources for managing hypercholesterolemia.

An Introduction to Hypercholesterolemia

Cardiovascular disease (CVD) remains the leading cause of death and a major cause of disability in western countries, and it is also becoming increasingly common in developing countries. The causes of CVD are multifactorial; cardiovascular (CV) risk is strongly influenced by lifestyle, especially an unhealthy diet, tobacco use, and sedentary habits, which are modifiable. Relevant roles are also played by other modifiable risk factors, such as high blood pressure, diabetes, and dyslipidemias, and by non-modifiable factors like age and male gender.1

Control of lipid levels is one of the most effective strategies for CVD prevention. Epidemiologic data have demonstrated the crucial role of dyslipidemia, especially hypercholesterolemia, in the development of CVD. It is well understood that the accumulation over time of cholesterol-rich low-density lipoprotein (LDL-C) leads to formation of lipid-laden foam cells and proliferation of atherosclerotic lesions in arteries, increasing the risk of CVD.1

Randomized clinical trials conducted over the past 20 years have consistently demonstrated that the aggressive reduction of LDL-C levels in the blood reduces CV risk in the settings of secondary prevention and high-risk primary prevention.2,3

 Hypercholesterolemia in the United States

  • In 2015–2016, more than 12% of adults age 20 and older had total cholesterol levels higher than 240 mg/dL, and more than 18% had high-density lipoprotein (HDL, or “good”) cholesterol levels of less than 40 mg/dL.4,5
  • Slightly more than half of US adults (55%, or 43 million) who could benefit from cholesterol-lowering medicine are currently taking it.4,6
  • 95 million US adults age 20 or older have total cholesterol levels higher than 200 mg/dL, and nearly 29 million adult Americans have total cholesterol levels higher than 240 mg/dL.4,7
  • 7% of US children and adolescents ages 6 to 19 have high total cholesterol levels.4,8
  • Since high cholesterol has no symptoms, many people are unaware that their cholesterol level is too high. A simple blood test can check cholesterol levels.4
  • Only about two-thirds of US adults say they have had their cholesterol level checked within the last 5 years.4,9


  1. Agabiti Rosei E, Salvetti M. Management of hypercholesterolemia, appropriateness of therapeutic approaches and new drugs in patients with high cardiovascular risk. High Blood Press Cardiovasc Prev. 2016;23:217-230.
  2. Ridker PM. LDL cholesterol: controversies and future therapeutic directions. Lancet. 2014;384:607-617.
  3. Ridker PM, Amarenco P, Brunell R, et al. Evaluating bococizumab, a monoclonal antibody to PCSK9, on lipid levels and clinical events in broad patient groups with and without prior cardiovascular events: Rationale and design of the Studies of PCSK9 Inhibition and the Reduction of vascular Events (SPIRE) Lipid Lowering and SPIRE Cardiovascular Outcomes trials. Am Heart J. 2016;178:135-144.
  4. High cholesterol facts. Accessed November 6, 2019.
  5. Carroll MD, Fryar CD, Nguyen DT. Total and high-density lipoprotein cholesterol in adults: United States, 2015–2016. NCHS Data Brief. 2017;290:1-8.
  6. Mercado C, DeSimone AK, Odom E, et al. Prevalence of cholesterol treatment eligibility and medication use among adults—United States, 2005–2012. MMWR Morb Mortal Wkly Rep. 2015;64:1305-1311.
  7. Benjamin EJ, Munter P, Alonzo A, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139:e56–e528.
  8. Nguyen D, Kit B, Carroll M. Abnormal cholesterol among children and adolescents in the United States, 2011–2014. NCHS Data Brief. 2015;228:1-8.
  9. Carroll MD, Kit BK, Lacher DA, Yoon SS. Total and high-density lipoprotein cholesterol in adults: National Health and Nutrition Examination Survey, 2011–2012. NCHS Data Brief. 2013;132:1-8.
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