New Cholesterol Treatment Guidelines Released

The third report of the National Cholesterol Education Program (NCEP) "Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults" emphasizes primary prevention of coronary heart disease in people with multiple risk factors and early and aggressive lipid-lowering therapy for those at highest risk. 

According to the National Institutes of Health, nearly three times as many Americans should reduce their risk of heart disease by taking cholesterol-lowering drugs than are actually taking them. In addition, those at risk and millions more ought to be eating fewer cheeseburgers, fries and other fatty foods.  Most Americans should also be exercising more and losing weight as a general health and heart protection strategy. 

According to new guidelines from the National Cholesterol Education Program (NCEP), heart disease risk is much higher than has been previously recognized. Heart disease already kills 500,000 Americans annually, making it the number one killer of men and women.  The new guidelines, published in the Journal of the American Medical Association (5/16/01) call for early cholesterol testing, recommend a diet with low levels of saturated fats and increased fiber, and urge people to strive for at least 30 minutes of exercise daily.

The new guidelines also included a set of recommendations specifically targeted toward women and older adults.  The bottom line is that the NCEP panel recommends that men and women be treated similarly, which is not currently standard practice. 

Before menopause, estrogen protects most women from developing cardiovascular disease. Estrogen raises good (HDL) cholesterol and lowers bad (LDL) cholesterol. As a result, women tend to develop coronary disease 10 to 15 years later than men (on average) and this condition is often overlooked as a major cause of morbidity and THE major cause of death in women.  After menopause, when a woman's body no longer produces estrogen, HDL levels tend to get lower and LDL and triglyceride levels rise.

One way to reduce this risk may be taking hormone replacement therapy  (HRT), although so far, results have been conflicting.  On the other hand, treatment of elevated cholesterol levels with a group of drugs called statins has not only been shown to be effective in women, but has also been shown to reduce morbidity and mortality from heart attacks and strokes. Physicians have generally been much quicker to prescribe statin therapy for men than for women.  Therefore, the NCEP panel recommends that men and women be treated similarly with regard to cholesterol-lowering.

Aging may be a confounding reason why women are not treated as aggressively as men.  There has been a misconception that older adults do not benefit as much from aggressive cholesterol-lowering therapy.  The new NCEP guidelines have addressed this and recommend that older persons should receive aggressive lipid-lowering therapy and lifestyle modification advice (stop smoking, increase exercise, improve dietary habits).

Most people get tested for their total cholesterol, but it's important to know what your LDL levels are as well.  The new guidelines recommend the following interpretation: 

Total Cholesterol		LDL Cholesterol
Less than 200	Desirable	less than 100
	Nearly there	100-129
200-239	Borderline high	130-159
240 and above	HIGH	160-189
	VERY HIGH	190 and above

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Created: 5/25/2001  -  Donnica Moore, M.D.