Cholesterol: An Ever-Changing Story ~~ Edith

[Guest guest]

Cholesterol: An Ever-Changing Story By Antonio M. Gotto Jr., MD, DPhil for

WebMD Health

webmd.com/content/pages/9/1675_57672

In the past few years, our understanding of cholesterol and the role it plays in

heart disease has improved dramatically. We now know that lifestyle changes and

drug therapy, when appropriate, can significantly reduce the risks for heart

attacks for many people. In individuals with a history of heart disease,

treatment also can help prevent strokes and death. In 2001, an expert panel

released the latest U.S. guidelines for managing cholesterol. What's new in

these guidelines that may be important to your heart health?

Even Moderately High Cholesterol Can Be Risky

First, doctors have a growing appreciation that high cholesterol works in tandem

with other risk factors to increase your risk for heart attack. We now have the

ability to estimate your risk for having a heart attack, using a calculation

that includes cholesterol, age, blood pressure, and smoking status. For

instance, if you've never had a heart attack and your calculated risk for having

one in the next 10 years is 20% or greater, the new guidelines recommend you be

treated as if you have already had a heart attack. Your doctor may begin

cholesterol-lowering treatment, even if your cholesterol levels alone don't seem

alarming, because your risk is high.

 

Second, we've identified a cluster of risk factors called the metabolic

syndrome. These risk factors may appear to be mild when considered individually,

but when added together, they can raise the risk for heart disease

significantly. Also called syndrome X or insulin resistance syndrome, this

condition is present when people have three of the following five

characteristics:

* A waist measurement of more than 40 inches for men or more than 35 inches for

women

* Blood pressure of 130/80 or higher

* High-density lipoprotein (HDL), the " good " cholesterol, less than 40

for men or less than 50 for women

* Triglycerides, another type of blood fat, of 150 or greater

* Blood sugar level of 110 or greater

The metabolic syndrome affects at least 47 million adults in the U.S. and can

also increase your risk for developing diabetes, another important risk factor

for early heart disease.

 

What other changes are in the new guidelines compared with previous guidelines?

* If you have diabetes, your risk is so high that guidelines recommend you get

as aggressive cholesterol treatment as if you had had a heart attack.

* Previously, a " good " cholesterol level of 35 or lower was too low.

Now an HDL level less than 40 is too low. An HDL of 60 or higher is ideal.

As a result of these changes, the number of people in the U.S. who may benefit

from cholesterol-lowering drugs has skyrocketed from 12 million to 36 million

people.

Know Your Numbers

Knowing your cholesterol numbers is important. Your total cholesterol level

should be no higher than 200. Your " good " cholesterol should be no lower than

40.

 

" Bad " low-density lipoprotein (LDL) cholesterol should be 100-130 or lower,

depending on your other risk factors. What we don't know is, " How low should you

go? " Trials under way are looking at treating LDL levels to as low as 70 to see

if you get additional protection. Today, drug therapy is optional for people

with LDL levels between 100 and 130. (An LDL below 100 is optimal.) Yet a new

study from the United Kingdom shows great benefits when people in that

borderline range are treated with a statin.

 

There are several treatment options. A healthy diet and exercise program can

reduce cholesterol levels for some people. For those who need more help,

medication can target a specific problem.

* Drugs called statins effectively lower LDL and have proven clinical benefits

in several trials.

* Drugs called fibrates can increase HDL and lower triglycerides, and they have

clinical benefits.

* Niacin can increase HDL and lower LDL and triglycerides.

* New drugs, such as " superstatins, " may have an even more dramatic effect on

LDL or may work well in combination with statins.

New research is examining whether inflammation plays a role in the development

of heart disease. A simple blood test could detect such inflammation. Scientists

are investigating genetic approaches that may directly attack heart disease and

cholesterol disorders. Another potential new approach involves a vaccine

designed to coax the body

into making more protective HDL while lowering LDL.

 

While the cholesterol story evolves, the major point remains the same: high

cholesterol is a key risk factor for heart disease that must be treated, without

a doubt.

 

Antonio M. Gotto Jr., MD, DPhil, is the dean of Weill Medical College of Cornell

University in New York City and a professor in the department of medicine.

Originally published May 2002.

Edited by Charlotte E. Grayson, MD, April 2002.

Back to A Special Report On Heart Health

 

© 2002 WebMD Corporation. All rights reserved.