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| New rules to fight heart
disease Aggressive treatment of 'bad' cholesterol Carl T. Hall, Chronicle Science Writer |
Wednesday, May 16, 2001
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Taking aim at a national epidemic of obesity and heart disease, federal health authorities issued a major revision of the official guidelines for managing high cholesterol yesterday. The new signposts, the first rewrite of national healthy-heart guidelines since 1993, are designed to help launch one of the most far-reaching preventive-health initiatives ever undertaken. If followed to the letter, the guidelines would dramatically increase aggressive treatment of the "silent killers" that cause heart attacks. Experts said there is a potential 40 percent reduction in rates of heart disease under the new criteria -- assuming people adhere to such standard, and widely ignored, nostrums as exercising half an hour daily and reducing dietary fat intake. The new advisory is a detailed script for doctors and other health professionals dealing with a nation of swelling midsections and thickening arteries. All told, heart disease kills about 500,000 people a year in the United States, more than cancer or any other type of ailment. As before, a level of 200 milligrams of total cholesterol per deciliter of blood is the recommended level. But the recommended level of the so-called "bad" form of cholesterol -- known as low-density lipoprotein, or LDL -- is dropped from 240 mg/dl to 160. Those at 130-159 are classified as "borderline high," while an LDL level above 190 now is considered "very high." It's considered a more sophisticated approach than merely targeting a single measure of cholesterol for reduction. Now, doctors are urged to give patients a complete "lipoprotein profile" every five years starting at age 20. That would include both the "bad" low-density lipoproteins and the "good" HDL or high-density form, as well as another form of harmful fat in the bloodstream known as triglycerides. Doctors now are advised to work up a comprehensive scoring system for heart attack risks that would take many factors into account, including age, total cholesterol, high LDL cholesterol, blood pressure and smoking. Those judged to be at a 20 percent risk or more of having a heart attack within the next 10 years -- even if free of current symptoms -- would be treated identically to those with classic evidence of heart disease. The vast majority would be prescribed fat-lowering drugs. The effect of following the guidelines to the letter would be a much more aggressive approach to heart health. Prescriptions for statins and other lipid- lowering drugs would triple from 12 million now to 36 million. Those targeted for dietary management to improve cholesterol levels would jump from 52 million people to 65 million. The new guidelines are being published today in the Journal of the American Medical Association by a high-powered panel of medical experts called the National Cholesterol Education Program. The panel was convened by the National Heart, Lung and Blood Institute, a part of the National Institutes of Health. Despite the radical sweep of the new advisory, experts said little will improve until more people start taking the risks seriously and doctors actively target for therapy what amount to cases of heart attacks waiting to happen. "It's all very well to put these guidelines out there, but they're not worth the paper they're printed on if patients aren't following them," said Dr. Michael Lauer, director of clinical research in cardiology at the Cleveland Clinic and co-author of an editorial about the cholesterol guidelines, also published in JAMA today. The guidelines represent the culmination of a decade of medical research and debate about the value of testing and managing fats in the blood. It is now considered beyond argument that more needs to be done to manage heart- disease risks, be it from too much artery-clogging fats or too little of the substances the body needs to keep the blood flowing. Syndromes we tend to shrug off as part of a middle-aged couch-potato lifestyle now would be viewed as death-dealing disease symptoms. Perhaps the most significant example is so-called metabolic syndrome, characterized by abdominal obesity. "That's medicalese for the guy with the big potbelly," Lauer said, noting that the syndrome amounts to a recipe for disaster, including high blood sugar, insulin resistance, low HDL, high triglycerides and high blood pressure. The guidelines for the first time recognize metabolic syndrome as a specific disorder that deserves serious medical attention. Although statin drugs may be in order for some people with that profile, the most important weapons absent other risks are likely to be exactly what people don't often want to hear -- exercise more, lose weight, eat less meat and saturated fats, eat more fish, fruits and vegetables. "Being overweight and sedentary is a strong stimulus to the liver to produce these triglyceride particles," said Dr. Stephen Fortmann, professor of medicine at Stanford University and director of the Stanford Center for Research in Disease Prevention. The good news, by the same token, is that those harmful consequences are "quite responsive to losing weight," he added, often enough to make medication unnecessary. However, doctors cautioned against middle-aged out-of-shape people suddenly getting religion and signing up at the gym without a doctor's advice. In fact, men over age 35 and women over 45 who have been sedentary and are considering an exercise program are advised to undergo a full exam, including an exercise test to see how much sweating they can safely handle. Sudden change in activity levels may work for a long-term
improvement in cardiac health. But you also raise the risk of
suddenly dropping dead during a workout. More information on the new guidelines may be found at the Web site www.nhlbi. nih.gov. New cholesterol guidelines The National Institutes of Health announced yesterday new guidelines on assessing healthy cholesterol levels. The new guidelines are expected to increase the number of Americans being treated for high cholesterol, raising the dietary treatment from 52 million to about 65 million people and cholesterol-lowering prescriptions from 12 million to 36 million. Decreasing levels of LDL (high-density lipoproteins) - Reducing intake of saturated fats. - Eating 10 to 25 grams of soluble fiber each day, like fruits, barley and legumes. - Reducing weight. Keeping waist circumference to less than 40 inches for men and 35 inches for women. Increasing HDL (high-density lipoprotein) levels - Increasing physical activity. - Quitting smoking. - Losing weight if needed. "Good cholesterol" High-density lipoproteins (HDL) do not cause lesions. HDL have receptors that pick up the "bad cholesterol" and take it to the liver for removal from the blood stream. "Bad cholesterol" Low-density lipoproteins (LDL) agitate artery cells and form lesions, allowing plaque to build up, closing the artery. 200 milligrams per deciliter total cholesterol is the desirable level Too low: <40 High: >60 Optimal limit: 100 Borderline high: 130-159 High: 160 Very high: 190
Source: National Institutes of Health Chronicle Graphic E-mail Carl Hall at chall@sfchronicle.com. |
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