Experts Urge a New Low for Cholesterol
New Guidelines Set for Highest Risk Patients, but Those at Less Risk Benefit, Too
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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.
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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 Scott 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 Smith, MD, tells WebMD. Smith 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.
Smith 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."
===============================================
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 Scott 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 Smith, MD, tells WebMD. Smith 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.
Smith 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."
