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Experts Urge Tighter Cholesterol Control

Recommended even lower levels for high-risk persons

MONDAY, July 12, 2004 (HealthDayNews) -- Heart experts say cholesterol-lowering drugs should be used more aggressively in people who are at risk of a heart attack, stroke or other cardiovascular event.

The new goal for people at highest risk, those who have more than a 20 percent chance of a heart attack or cardiac death within 10 years, should be blood levels no higher than 100 milligrams per deciliter of LDL cholesterol, the "bad" kind that clogs arteries. That objective comes in new guidelines recommended by the National Cholesterol Education Program (NCEP), a joint effort of the American Heart Association, the American College of Cardiology and the National Heart, Lung, and Blood Institute.

The old guidelines said LDL cholesterol levels should be no higher than 130 milligrams per deciliter for high-risk persons, those who have already had a heart attack, or have a combination of risk factors -- cardiac chest pain (angina), diabetes, obstructed blood vessels and obesity.

The new guidelines are based on the results of trials conducted in the last few years, said Dr. Scott Grundy, director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center and chairman of the panel that made the recommendation.

"Evidence from many trials on cholesterol lowering has been accumulating rapidly," Grundy said. "Our last report was in 2001. Since that time there have been five major trials, so we felt the field needed new guidelines."

The guidelines appear in the July 13 issue of the American Heart Association journal Circulation.

Those guidelines include the option of reducing LDL cholesterol to less than 70 milligrams per deciliter for persons at very high risk of heart attack or death, such as persistent cigarette smokers and those with existing cardiovascular disease and diabetes, poorly controlled high blood pressure, or a combination of other risk factors including very low levels of HDL cholesterol, the "good" kind that prevents blockage of the arteries.

"It is very important to emphasize that the recommendations for more aggressive treatment of cholesterol in no way suggests that behavior modifications and diet are not important," said Dr. Sidney Smith, chief of cardiology at the University of North Carolina, a member of the panel and a spokesman for the American Heart Association.

"These recommendations do not mean that Americans should ignore important advice on diet, exercise and weight loss," Smith said. "We're not saying that all you have to do is take a pill."

For persons at moderately high risk, meaning they are estimated to have a 10 percent to 20 percent chance of a heart attack or cardiac death within 10 years, the guidelines call for keeping LDL cholesterol levels no higher than 130 milligrams per deciliter, with an option of reducing them to 100 milligrams per deciliter.

The decision on the aggressiveness of treatment should be made patient by patient, Grundy said. "High doses of drugs can cause side effects, so there is a potential downside to pushing cholesterol levels way down," he explained.

Age should not be a consideration, according to the guidelines. The study results indicate that it is never too late to benefit from reducing high levels of LDL, Grundy said.

As a general rule, drug treatment in people at high or moderate risk should be aimed at reducing LDL cholesterol levels by 30 percent to 40 percent, the guidelines say.

More information

A guide to lowering cholesterol can be found at the National Heart, Lung, and Blood Institute.

SOURCES: Scott Grundy, M.D., director, University of Texas Southwestern Medical Center, Dallas; Sidney Smith, M.D., chief, cardiology, University of North Carolina, Chapel Hill; July 13, 2004, Circulation
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