What treatment should be initiated for patients with LDL levels greater than 190?

For patients with LDL (low-density lipoprotein) levels greater than 190 mg/dL, initiating statin therapy is the most appropriate treatment. Statins are effective in significantly lowering LDL cholesterol levels and reducing the risk of cardiovascular events.

Patients with very high LDL levels, particularly over 190 mg/dL, are considered to be at high cardiovascular risk, even if they do not have other risk factors such as diabetes or a history of heart disease. Statins not only decrease LDL levels but also have additional benefits, including stabilizing atherosclerotic plaques and reducing inflammation within the arterial walls, which further lowers the risk of heart attack and stroke.

While dietary changes and an exercise plan are important components of a comprehensive approach to managing cardiovascular health, they are generally not sufficient alone for such high LDL levels. Fibrate therapy is typically used in patients with high triglycerides rather than primarily for lowering LDL cholesterol. Therefore, statin therapy is the recommended first-line treatment for managing significantly elevated LDL levels in order to effectively reduce cardiovascular risk.