How worried should i be with total cholesterol 280 , 30 yr old female. just started pravastin. seems to be hereditary, is it meds forever?

Depends: Depending on just which kind of problem you have inherited, and where your weight and diet are now, you may be able to get off medications with exercise & diet. Even if the genetics are against you, diet and exercise will decrease the amount of medication you will need to control your levels. If you can hack it, a vegan diet may be for you. Good luck!

Moderately.: It would definitely be wise to make it part of your lifestyle to lower/keep low your cholesterol to a reasonable degree. You are young, and this could effect your future life. Medication is likely to be important, and prevastin, a statin is a strong drug that can have side effects, like muscle pain that needs medical attention. Diet control and exercise is also important now and in the future.