- The Washington Times - Wednesday, May 16, 2001

The nations heart doctors are lowering the threshold for how much cholesterol we should have floating around our bloodstreams.
New guidelines issued yesterday were developed over nearly two years by 27 of the nations top cholesterol specialists. They are expected to step up cholesterol screening, impose new diet restrictions and add prescriptions for cholesterol-lowering drugs for more than half of all American adults.
While artery-clogging low-density lipoproteins are still considered the chief target for diet and therapy, the report from the National Cholesterol Education Program also establishes new parameters for "good" cholesterol, high-density lipoproteins (any HDL level below 40, rather than 35, is now considered low), and sets up a new risk-assessment regimen for everyone starting at age 20.
"A man with a waistline of 40 inches, triglycerides of 180 and high-density lipoprotein of 40 might have sailed through the previous guidelines, but now we will catch that person and provide the lipid management he needs," said Dr. Ronald Krauss, head of the American Heart Associations council on nutrition, physical activity and metabolism.
"Americans at high risk for a heart attack are too often not identified and so dont receive sufficiently aggressive treatment," said Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute, which coordinated release of the guidelines. The recommendations also were being published today in the Journal of the American Medical Association.
"Studies show conclusively that lowering the level of LDL, the 'bad cholesterol, can reduce the short-term risk for heart disease by as much as 40 percent. Treatment may lower risk over the long term, beyond 10 years, even more. So thats why, while the intensity of treatment in the new report is stepped up, the primary aim remains squarely on lowering LDL."
The heart association estimates that more than 100 million American adults have total blood cholesterol levels of 200 to 239 milligrams per deciliter — borderline high — and about 40 million have levels of 240 and above.
The guidelines also add a new scale for LDL cholesterol, setting levels of 100 as optimal; up to 129 as near-optimal; 130 to 159 as borderline high; 160 to 189 as high and any level at or above 190 as very high.
But more than just numbers, the new risk-assessment tool will allow doctors to better customize treatment for people based on their specific individual heart-disease risk factors.
"We now know that cholesterol-lowering treatment is more effective when its intensity closely matches the level of risk," said Dr. Scott Grundy, head of the panel that wrote the new guidelines and director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center in Dallas. Dr. Grundy also noted that the guidelines stress "therapeutic lifestyle changes."
These include cutting intake of saturated fats to less than 7 percent of total calories and cholesterol intake to less than 200 mg a day; enhancing LDL lowering by eating 2 grams a day of either plant stenols or sterols, found in certain margarines and salad dressings, or 10 to 25 grams of soluble fiber (grains, beans, fruits and vegetables) each day; reducing weight (men getting their waistlines to less than 40 inches; women to less than 35 inches); and stepping up physical activity, which boosts HDL levels.
The guidelines are expected to triple the number of Americans taking cholesterol-lowering drugs to some 35 million.

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