Many studies show that people with high cholesterol levels should be treated with cholesterol-lowering drugs, but aren't. And guidelines published last year have lowered the mark even further, categorizing more people as having high cholesterol levels making them candidates for cholesterol-lowering treatments.
According to the American Heart Association (AHA), more than 100 million adults in the United States have blood cholesterol levels considered borderline high (over 200), and close to 40 million adults have levels considered high (over 240). High cholesterol levels are strongly linked to an increased risk for heart disease, which is the leading killer of both men and women in the United States, accounting for about 500,000 deaths each year.
National Cholesterol Education Program (NCEP) guidelines, published in 2001 focus on preventing heart disease by reducing low-density lipoprotein cholesterol (LDL, the "bad" cholesterol) levels with lifestyle changes and medication. The old guidelines, issued in 1993, focused on a person's total cholesterol level, including both LDL and high-density lipoprotein cholesterol (HDL, the "good" cholesterol).
"New evidence shows without doubt that lowering the low-density lipoprotein cholesterol is beneficial," says Scott Grundy, MD, chairman of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults that developed the guidelines. "These guidelines will provide confidence for physicians to treat their patients appropriately."
20 and Older
The guidelines say that everyone age 20 and older should have blood tests to measure their lipoprotein profile every 5 years. A lipoprotein profile tells you your LDL and HDL cholesterol levels as well as your triglyceride (another fat in the blood) level.
If your LDL cholesterol level is 130 or higher, you should start taking cholesterol-lowering drugs and make lifestyle changes -- like having less saturated fat and cholesterol in your diet, losing weight, and exercising more -- to reach an LDL level of less than 100.
Michael Lauer, MD, a cardiologist at the Cleveland Clinic Foundation, in Cleveland, Ohio says the guidelines reflect a better understanding of how managing high cholesterol prevents heart disease.
"There is a need to be even more aggressive and vigilant about treating cholesterol disorders in the population," he says.
Lauer says that people who should be taking cholesterol-lowering drugs usually aren't. "The problem we have right now is that we have treatment that works and [preventive methods that work] but are not being used," he says
Using these guidelines, Ronald Krauss, MD, chairman of the AHA Council on Nutrition, Physical Activity and Metabolism, says that doctors now have a better way to identify people at risk for heart disease and give them the best care.
"Physicians now have new tools for sharpening up their assessment of their patients' risk for heart disease or for recurring heart disease," says Krauss. "They will have very specific recommendations for using both diet and medication where needed to achieve targets that are connected to their patients' risk."
One area of risk that deserves emphasis, he says, is the distribution of body fat, like the like the "apple" body type (fat around the midsection) which has been linked to a higher risk of heart disease. People with an apple-shaped distribution of fat may need more aggressive treatment of borderline cholesterol to lower their risk.
Another condition called the "metabolic syndrome" is another major risk for heart disease. The metabolic syndrome is a combination of the apple body type, high blood pressure, a high triglyceride level, low HDL cholesterol, and high blood sugar.
"Insulin resistance [the inability to use the hormone insulin] is responsible for metabolic syndrome, which has become more significant over the years since more Americans are overweight," says Krauss. "The key treatment for this is to reduce weight and increase physical activity. It deserves to be aggressively treated." Insulin resistance can lead to diabetes.
Krauss describes the typical person with borderline metabolic syndrome as a man with a waistline of 40 inches, a triglyceride level of 180, and an HDL level of 40. "That person might have sailed through the previous guidelines," says Krauss. "But now, we will catch that person and provide the lipid management he needs."