New Cholesterol guidelines

[Guest guest]

New LDL cholesterol guidelines just came out today. This represents

a major change from the prior NCEP guidelines.

Here's a news story that discusses it.

If anyone has access to the report itself, appreciate an e-mail with

it. I believe this is coming out tomorrow in the journal Circulation.

rjb112@...

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Experts Urge a New Low for Cholesterol

By Salynn Boyles

WebMD Medical News Reviewed By Brunilda Nazario, MD

on Monday, July 12, 2004

July 12, 2004 -- The nation's top heart groups are calling for more

aggressive cholesterol treatment of people at the highest risk of

dying from heart attacks and strokes.

The message from the clinical trials that prompted the guideline

changes is clear, the experts say. When it comes to low-density

lipoprotein (LDL), or " bad, " cholesterol, the lower the levels, the

better it is for those with cardiovascular risk factors.

The report, released today by the National Cholesterol Education

Program (NCEP), reduces target LDL levels from 100 mg/dL to 70 mg/dL

for those at the very highest risk for heart disease. For people at

high risk for heart disease, the target for LDL lowering remains the

same. In this group medical therapy with statins should lower LDL to

a target of less than 100 mg/dl, the report shows.

The guideline changes are endorsed by the American Heart Association,

the National Heart, Lung, and Blood Institute, and the American

College of Cardiology, and are published in the July 13 issue of the

journal Circulation.

Assessing Risk

The updated recommendations mean that almost all high-risk people

with LDL cholesterol levels of 100 mg/dL or higher should be on lipid-

lowering statin drugs, NCEP chairman M. Grundy, MD, tells

WebMD.

" People at very high risk can benefit from getting their cholesterol

level as low as possible, " Grundy tells WebMD. " If they can get to an

LDL of 70 with medication that is ideal. If not, then we would like

to see a 40% reduction with treatment. "

Very high risk individuals already have cardiovascular disease and

also have diabetes, poorly controlled high blood pressure, or

metabolic risk factors including obesity, high triglycerides, and low

high-density lipoprotein (HDL) " good " cholesterol. A smoker with

heart disease is also considered to be at very high risk. For these

individuals -- a subset within the high risk category -- the goal of

therapy is to lower LDL to under 70 mg/dl.

For high-risk individuals -- people with coronary heart disease or

diabetes or multiple risks factors -- LDL cholesterol should be

treated to a goal of 100 mg/dl or less. This recommendation is

unchanged for prior recommendations.

Moderately high risk is defined as having multiple risk factors for

cardiovascular disease with a 10% to 20% chance of having a heart

attack or cardiac death within a decade. In prior recommendations

statin therapy was started if the LDL was above 130 mg/dl to get the

level to below 130. The new recommendations have lowered the

threshold at which drug therapy is started. Current recommendations

say that if the LDL level is between 100-129 mg/dl then a statin drug

may be started. The goal of medical therapy would be to lower LDL to

less than 100 mg/dl. Research shows therapeutic benefits with more

aggressive treatment.

Recommendations for people at lower or moderate risk remain

unchanged. For these people, dietary changes and exercise may be

adequate unless LDL levels are very high.

To calculate your 10-year coronary heart disease risk, go to the

National Heart, Lung, and Blood Institute web site

(www.nhlbi.nih.gov), and click on 'Health Assessment Tools,' and then

the '10-Year Heart Attack Risk Calculator.'

Lifestyle Still Critical

While the most recent research shows the importance of statin therapy

for reducing cardiovascular risk, the NCEP report reemphasizes the

importance of making heart-healthy lifestyle changes such as losing

weight, exercising, and quitting smoking.

" While lipid-lowering therapy is very effective, making these

lifestyle changes is no less important, " cardiologist Sidney ,

MD, tells WebMD. directs the Center for Cardiovascular Science

and Medicine at the University of North Carolina, Chapel Hill, and is

a past president of the American Heart Association.

says three major trials assessing the impact of statin therapy

on cardiovascular outcomes should help further refine treatment

strategies within the next two years.

" They may give us a better idea of just what the optimal target

should be, " he says. " But it certainly appears that going to 100 or

lower is beneficial for people at high risk. When it comes to LDL

cholesterol, the lower the better. "

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SOURCES: Grundy et al., Circulation, July 13, 2004; online edition.

M. Grundy, MD, director, Center for Human Nutrition, University

of Texas Southwestern Medical Center, Dallas. Sidney , MD,

professor of medicine; and director, Center for Cardiovascular

Science in Medicine, University of North Carolina, Chapel Hill; and

past president, American Heart Association.

© 2004 WebMD Inc. All rights reserved.