Dodging the Dangers of High Cholesterol

More Americans are aware of the hazards, but not everyone takes them to heart

FRIDAY, Sept. 12, 2003 (HealthDayNews) -- While more Americans know about the dangers of high cholesterol, many of them aren't doing anything about it.

"Our survey data shows that awareness over the last 20 years has grown enormously," says Dr. James Cleeman, coordinator of the National Cholesterol Education Program at the National Heart, Lung, and Blood Institute. "People can identify that high cholesterol is a risk factor for heart disease and that they ought to do something about it."

"But sometimes," Cleeman adds, "the problem is what they know and what they do are not necessarily lined up."

About 102 million Americans have total blood cholesterol levels of 200 milligrams per deciliter and higher -- which is above what's deemed desirable, according to the National Center for Health Statistics. Of those, 41.3 million have levels of 240 and higher, which is considered high risk.

All of these people should take action, says Cleeman, who notes that dietary and lifestyle changes can lower their risk of heart disease or, if they already have heart disease, their risk of dying from it or having bypass surgery.

In light of that, September has been designated National Cholesterol Education Month by the National Institutes of Health (NIH).

"We want people to know their numbers and know their risk," says Cleeman, who adds that the NIH released new practice guidelines in 2001 calling for more aggressive treatment of high cholesterol.

People should be aware of not only their total cholesterol, but also their levels of so-called "good" HDL cholesterol, "bad" LDL cholesterol and triglycerides, which are fatty compounds in the blood.

HDL levels should be 40 milligrams per deciliter or higher, LDL levels should be less than 100 and triglycerides should be less than 150.

Under the new guidelines, adults are advised to have their cholesterol levels checked at least every five years.

Several years ago, some research suggested that once you're past a certain age, cholesterol levels might not have to be watched so closely. But Cleeman and another expert, Dr. Daniel Lee, say more recent research refutes that notion.

It's wise for patients over the age of 70 to keep an eye on cholesterol, says Lee, a faculty member at the Santa Monica-UCLA Medical Center family practice residence program and an assistant clinical professor of family medicine at the University of California, Los Angeles' David Geffen School of Medicine.

Cleeman points to a study, published in The Lancet in late 2002, showing that taking cholesterol-lowering drugs reduced deaths from heart disease by 24 percent in the group that took the drugs instead of a placebo.

Some people can manage their high cholesterol with an improved diet and exercise, says a recent study published in the Journal of the American Medical Association.

Researchers also found recently that eating a low-fat diet high in fiber, nuts and vegetable proteins was sometimes as successful as drugs in lowering cholesterol.

For some patients, Lee and other experts first recommend lifestyle changes, such as a healthful diet with less than 30 percent of total calories from fat (both fat and cholesterol in the diet drive up blood cholesterol, but experts say fat is the main culprit). He also advises exercising three to five times a week for at least 30 minutes.

If the lifestyle change is going to work, Lee finds, "you will usually see the full effect in about a month or two."

Then, he reevaluates the person to see if cholesterol-lowering drugs, such as statins, should be added to the routine.

Both Cleeman and Lee agree that if lifestyle changes don't work, no one should feel like a failure for having to go on medication. For some, the combination approach works best.

And certain patients, including those with risk factors such as diabetes, might be prescribed medications along with lifestyle improvements from the start.

More information

For details on how to control cholesterol, go to the American Heart Association. For the most recent government guidelines on high cholesterol, see the National Heart, Lung, and Blood Institute.

SOURCES: James Cleeman, M.D., coordinator, National Cholesterol Education Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md., Daniel Lee, M.D., faculty member, Santa Monica-UCLA Medical Center Family Practice Residency Program, Santa Monica, Calif., and assistant clinical professor, family medicine, University of California, Los Angeles' David Geffen School of Medicine
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