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NIH issues tougher guidelines for cholesterol

Dr. Claude Lenfant, National Heart, Lung, and Blood Institute
Dr. Claude Lenfant, National Heart, Lung, and Blood Institute  


(CNN) -- An epidemic of heart disease among Americans has prompted the National Institutes of Health to issue aggressive new guidelines that would more than double the number of people taking drugs to lower their cholesterol.

However, lifestyle changes, not drugs, remain the first line of defense against heart disease, the researchers said.

Prevention is the anchor of the new NIH standards, which lower the optimal levels for cholesterol and add diabetes to the list of risk factors for heart disease. NIH has developed a computer program that predicts the likelihood of a person having a heart attack within the next 10 years, and researchers want to get the message out to physicians and the public.

Heart disease kills about 500,000 Americans each year, and cholesterol is the dominant risk factor for heart attack, said Claude Lenfant, director of the National Heart, Lung and Blood Institute.

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See some of the new guidelines for lowering cholesterol
 

"The combination of these two things, predicting the risk of heart attack in persons and our ability to address the problem of high cholesterol gives us an extraordinarily powerful tool to decrease the death risk for heart attack," explained Lenfant.

To that end, the NIH guideline changes include: a new set of "therapeutic lifestyle changes"; aggressive cholesterol-lowering treatment; better identification of risk factors; more attention to the "metabolic syndrome" or insulin resistance syndrome; and a lower level at which high-density lipoprotein (HDL, or "good cholesterol") becomes a risk factor.

Current guidelines list 200 milligrams per deciliter of total cholesterol as the desirable level, over 240 as high, and less than 35 milligrams of HDL as too low.

The new guidelines remain the same for total cholesterol, but add that 100 milligrams of LDL is optimal. The NIH lists 130-159 as borderline high, 160 as high, and 190 as very high. The minimum reading for HDL rises from 35 to 40 milligrams.

Those changes are expected to swell the number of Americans taking cholesterol-lowering drugs from 13 million to 36 million, and those on dietary restrictions for the condition from 52 million to 65 million.

 Dr. James Cleeman, National Cholesterol Education Program
Dr. James Cleeman, National Cholesterol Education Program  

The numbers are projections only, said James Cleeman of the National Cholesterol Education Program, since many patients and doctors do not adhere to current recommendations.

"The new guidelines thus recommend drug treatment to the people who will gain the greatest benefit from it," said Cleeman. "The increase in the number of people who require drug treatment reflects the high level of heart disease risk among Americans."

Concern about the 'metabolic syndrome'

The metabolic syndrome is made up of individual risk factors, which raise the risk for coronary heart disease, according to the Center for Human Nutrition, at the University of Texas Southwestern Medical Center. Risk factors include high triglycerides, small LDL particles, low HDL cholesterol, high blood pressure, high blood glucose, a tendency for blood clotting (thrombosis), and chronic inflammation. Each risk factor of the syndrome appears to promote atherosclerosis.

 Dr. Scott Grundy, University of Texas Southwestern Medical Center
Dr. Scott Grundy, University of Texas Southwestern Medical Center  

"The metabolic syndrome has emerged as being as strong a contributor to early heart disease as cigarette smoking," said Dr. Scott Grundy of the Center.

The guidelines recommend that people over age 20 have lipoprotein analysis once every 5 years; define a low HDL cholesterol level as being less than 40 milligrams per deciliter, instead of 35; encourage use of certain foods that contain plant stanols and sterols, or are rich in soluble fiber, to reduce LDL; and identify metabolic risk factors for heart disease as: excess abdominal fat (or a large waist), low HDL levels and elevated triglycerides.







RELATED STORIES:
RELATED SITES:
• National Cholesterol Education Program
• American Heart Association
• National Institutes of Health

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