What action should be taken if an LDL level is greater than 190?

When an LDL level exceeds 190 mg/dL, the recommended action is to start statin therapy. This recommendation is based on established clinical guidelines aimed at reducing cardiovascular risk. High LDL levels are a significant risk factor for the development of atherosclerosis, which can lead to serious cardiovascular events such as heart attacks and strokes.

Statins are effective in lowering LDL cholesterol levels and have a well-documented impact on reducing cardiovascular morbidity and mortality. Initiating statin therapy at this LDL level directly addresses the elevated cholesterol and helps to manage the patient's overall cardiovascular risk profile.

While lifestyle changes and regular follow-ups are important components of overall cardiovascular health management, they do not have the immediate impact on substantially lowering high LDL levels in the way that statins do. Additionally, while further testing might be appropriate in certain scenarios (such as evaluating secondary causes of hyperlipidemia), it is not necessary when the LDL level is this high and the treatment is clear. Therefore, starting statin therapy is the most appropriate and effective action in this case.