GOVERNMENT WANTS MORE PEOPLE TO BE TESTED, TREATED FOR HIGH CHOLESTEROL

COMMONLY ACCEPTED LEVELS ARE NOT SAFE, REPORT SAYS

By Virginia Baldwin Gilbert
Of the Post-Dispatch

May 16, 2001

Millions of Americans with blood-cholesterol levels they may have thought acceptable could be at higher risk of heart disease and strokes.

A report released Tuesday by the National Institutes of Health recommends tougher guidelines for the prevention and management of fatty substances in the blood -- triglycerides and the two types of cholesterol -- that are linked to cardiovascular disease.

The panel's recommendations could nearly triple the number of people using cholesterol-lowering drugs and make widespread more complicated screening tests.

Federal health officials say 65 million Americans should be treated for high cholesterol with dietary changes and 36 million with prescription drugs. That compares now with 52 million who observe diet restrictions and 13 million who take such drugs.

Most of all, the medical profession wants people to find out their cholesterol levels and use that knowledge to keep from dying of heart disease and stroke, says Dr. Jerome D. Cohen, a professor in cardiology at St. Louis University School of Medicine and director of its preventive cardiology programs.

"We've got a preventable disease here," Cohen said. "We can detect your high risk before you get it, and lower the risk. We couldn't say that 10 years ago."

The report underscores familiar exhortations to control weight, increase exercise and reduce low-density lipoproteins, or LDL -- the so-called "bad" cholesterol.

But the government is making a strong new statement about the need to increase high-density lipoproteins, or HDL -- the so-called "good" cholesterol -- through diet and medication, if necessary.

"They're using the same guideposts, but changing the aggressiveness" of treatment, said Dr. Edward M. Geltman, a medical school professor at Washington University and director of the heart failure program at Barnes-Jewish Hospital.

That is, the measurement of cholesterol in the blood is the same - the number of milligrams of cholesterol per deciliter of blood.

But the figures considered too high or too low have changed. And the level at which the government is advising doctors to push beyond life-s tyle changes and use drugs has also been changed.

The new guidelines aim for LDL levels at or below 100 - instead of 130 for heart patients and 160 for healthy adults - and for HDL levels above 40 - instead of above 35.

"Americans have, on average, improved," Cohen said. "This is pushing us more in the right direction."

The guidelines also urge doctors to use a more precise blood test - called a lipoprotein profile - as the first screening for high cholesterol. This profile measures levels of LDL, HDL, total cholesterol and triglycerides and requires patients not to eat anything for 12 hours before the test. The other widely used blood test measures only total cholesterol and HDL and does not require fasting.

Balancing these fatty substances "ends up being more complicated as we get more information," Geltman said. Raising the HDL level calls for different drugs and diet from those recommended to lower the LDL level, and they are both somewhat different from the regimen for reducing triglycerides, he said.

But all of the levels can be changed through behavior, as well as drugs, doctors say.

The report targets a collection of symptoms called a "metabolic syndrome," characterized by too much abdominal fat, high blood pressure, high triglycerides and low HDL.

This metabolic syndrome "has emerged as being as strong a contributor to early heart disease as cigarette smoking," said Dr. Scott Grundy, chairman of the report and director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center in Dallas. "It is very important to recognize the syndrome and treat it with lifestyle changes."

The panel recommends Americans eat no more than 7 percent of their calories in saturated fat and eat food with no more than 200 milligrams of cholesterol a day.

But it also raises the percentage of nonsaturated fat that should make up our diet - to 35 percent of calories instead of 30 percent.

Cohen said that the increase in unsaturated fat was directed by a concern for triglycerides, which can rise in people who eat a lot of carbohydrates - sugars and starches. Getting about a third of your calories from "healthy" fat, in the form of vegetable oils such as corn oil, olive oil or safflower oil can help keep triglycerides under control, Cohen said.

The panel reports that people can reduce LDL by eating foods high in fiber, such as cereal grains, beans, peas, legumes, and many fruits and vegetables.

Sources: National Institutes of Health, U.S. Food and Drug Administration, American Heart Association; Heart Information Network; The Dorling-Kindersley Illustrated Guide to the Human Body; The Philadelphia Inquirer

WHAT YOU NEED TO KNOW

Your blood cholesterol has a lot to do with your chances of getting heart disease. The higher your blood cholesterol level, the greater your risk. Heart disease is the No. 1 killer of women and men in the United States. Each year, more than 1 million Americans have heart attacks, and about 500,000 people die from heart disease.

GOOD AND BAD CHOLESTEROL

Cholesterol is a fatlike substance the body needs to build cell walls, make hormones and process fats. It travels inside lipoprotein molecules. Low-density lipoprotein (LDL) carries excess cholesterol back to the liver, which disposes of it.

LDL CHOLESTEROL: Too much is considered bad because it is a major component of plaque that can form inside arterial walls, causing arteries to narrow. High levels are associated with heart disease.

HDL CHOLESTEROL: High levels are considered good because it is needed to rid the body of excess cholesterol. Low levels are associated with heart disease.

TRIGLYCERIDES: The other lipoprotein measured in evaluating heart disease. High levels are associated with heart disease.

HOW CHOLESTEROL ENTERS THE BLOODSTREAM

1. Through the stomach as we digest foods that are high in saturated fats.
2. Through the liver, which produces cholesterol, as well as helps to eliminate it.

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