We hear a lot about cholesterol. HDL, LDL, it's confusing; but we know too much cholesterol raises the risk of "cardiac events," like heart attack. "HDL" is supposed to be the "good" cholesterol, and "LDL" is the bad stuff (remember "l" for low, or "l" for lousy). If we're wise, we get our blood cholesterol tested regularly; and, if it is elevated, we modify our diet and take appropriate medications (generally the statins), to bring our numbers down.
How far down? For years we've been told, to be safe, that if we are at "high risk," our LDL cholesterol should run no higher than 100 mg/dl. Those numbers just changed.
The National Heart, Lung, and Blood Institute's National Cholesterol Education Program (NCEP), a US Government-funded research initiative, has just revised its initial (2001) guidelines. Where the old guidelines recommended a target of 100 mg/dl, and aggressive treatment of LDLs over 130, the new, much lower target is an LDL of 70 mg/dl, with doctors encouraged to prescribe statins for "high-risk" individuals whose LDLs are 100 or more. Just as with the downward revision of blood glucose targets in the past few years, this change is designed to get corrective action in place sooner, heading off the need for bypass surgery, and further reducing the likelihood of heart attack or stroke. Bringing the numbers down farther, taking action sooner than before, keeps you in better health.
This revision has been very well researched. Four major studies provided the data: The Heart Protection Study (20,535 individuals), the PROSPER (Prospective Study of Pravastatin in the Elderly at Risk; 5804 individuals), the ASCOT-LLA (Anglo-Scandinavian Cardiac Outcomes Trial--Lipid-Lowering Arm; 10,305 individuals), and the PROVE IT (Pravastatin or Atorvastatin Evaluation and Infection Trial; 4162 patients).
Who needs to be tested for cholesterol? Everybody age 20 or older, according to the NCEP. There is a hierarchy of "risk factors," and it is complex and difficult to explain. The best way to deal is to look at the following list. The more of these factors apply to you, the more urgent it is for you to get your cholesterol tested, and to take aggressive action to bring your numbers down. So, what places you at higher risk?
If you are obese, diabetic, have a family (or personal) history of heart disease, are a smoker, have high blood pressure, are a male over age 45 or a female over age 55, have low HDL cholesterol, have angina (heart pain), have high triglycerides ("blood fats"), or have had a previous angioplasty or heart bypass, you are at risk for a serious cardiac event. The more risk factors, the greater the risk. And heart attacks are very serious business.
Get yourself checked. It's like with your car: "If you can't remember the last time you checked it, you need to check it now." If your cholesterol is where it should be, great -- one less thing to worry about (and that knowledge can help your blood pressure). If your LDL cholesterol is elevated, the medications called the statins (Zocor, Lipitor, Lescol, Pravachol, Crestor, Mevachor, and Altocor) can bring it back down far more quickly and safely than can diet alone.
What about dietary cholesterol? High-cholesterol foods are generally high-fat and high-carbohydrate, too, and not really good for your meal plan -- but most of your body's cholesterol doesn't come from what you eat. Your body manufactures it, in the liver.
The statins interfere with the production of new cholesterol in the liver. Since the body needs a certain amount of the stuff, if the liver is not producing, the body will then get it from the blood -- thus bringing down your blood cholesterol numbers, and decreasing your likelihood of heart attack and stroke.
It's very complicated, and the numbers alone do not tell the whole story. You need to discuss your cholesterol test results and your risk factors with your doctor. Take action!