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:
|Less than 200
|| less than 100
|240 and above
|| 190 and above
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Created: 5/25/2001  - Donnica Moore, M.D.