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Heart Deaths: Cholesterol a Culprit

Analysis Shows Lowering Total Cholesterol Decreases Deaths From Heart Disease
By
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 29, 2007 -- High cholesterol is a major risk factor for death from heart disease, but its impact on stroke death is less clear, a new analysis combining 61 studies confirms.

In one of the largest evaluations of the research examining cholesterol and mortality ever conducted, researchers found lower total cholesterol to be strongly protective against death from heart attack for both men and women.

Roughly 34,000 deaths from heart disease and 12,000 deaths from stroke were recorded among the almost 900,000 participants in the studies.

Among adults between ages 40 and 89, a reduction in total cholesterol of 39 mg/dL (or 1 mmol/L) was associated with about a 33% reduction in heart disease deaths.

Among those aged 50 to 69 and 70 to 89, respectively, 1 mmol/L lower total cholesterol was associated with 34% and 17% reductions in the risk of death from heart disease.

"The message is clear with regard to heart disease," researcher Sarah Lewington, DPhil, of the University of Oxford, tells WebMD. "If you are at risk for heart disease or have it, the lower your cholesterol, the better."

Cholesterol and Stroke Death

But important questions remain about the impact of cholesterol levels on death from stroke.

While studies of cholesterol-lowering statin drugs unequivocally show the drugs to be protective against stroke, most observational studies like the ones included in the latest analysis have failed to show a strong relationship between blood cholesterol levels and death from stroke.

Some have even shown low total cholesterol to be associated with an increased risk of death in elderly patients.

"We don't really understand these findings, and they certainly invite future research," Lewington says. "But the evidence from randomized trials clearly shows that lowering cholesterol with statins has a positive impact on stroke risk. No one is saying that lowering cholesterol is bad news for strokes."

The Message to Patients

American Heart Association (AHA) spokeswoman Barbara V. Howard, PhD, says despite the confusing findings, it is clear that keeping cholesterol under control is one of the best ways to avoid heart attack and stroke.

Howard leads the AHA council on nutrition, physical activity, and metabolism and is president of MedStar Research Institute in Hyattsville, Md.

"Start with diet, exercise, and weight control -- and if that doesn't do it, medication probably will," she tells WebMD. "There is no question that lowering cholesterol also lowers stroke risk."

Lewington and colleagues agree that the public health message is unambiguous.

"Treatment should be guided principally by the definitive evidence from randomized trials, [showing] that statins substantially reduce not only coronary event rates but also total stroke rates in patients with a wide range of ages and blood pressures," they write.

Is This Normal? Get the Facts Fast!

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0-199
Borderline
200-239
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240+

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Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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