KEEP AN EYE ON YOUR CHOLESTEROL NUMBERS

What are your cholesterol numbers? Revised guidelines call for lower numbers. Do the changes affect you?

The last time you heard, your cholesterol was OK. Maybe you don’t remember the exact numbers, but you do remember your doctor telling you things were fine.

But now you hear on the news that everything’s changed. Cholesterol levels that once were considered OK are now too high. Millions of Americans suddenly are being told they should be on cholesterol-lowering medication.

What does this mean for you? Has your health suddenly changed just because someone put out new cholesterol guidelines?

No, your health hasn’t changed, says Sidney Smith, MD, chief science officer for the American Heart Association. But we have learned more about the causes for heart disease, and based on this new information, it’s possible that you are at higher risk than previously thought.

Risk, LDL's and HDL's
There are a number of risk factors for heart disease, including smoking, obesity, physical activity, family history and cholesterol levels.

Cholesterol is a waxy substance found in your blood. Your body needs it in order to function. However, not all cholesterol is good, and too much can be very bad. Eating fatty foods is one way to build up unhealthy cholesterol levels.

Low-density lipoproteins, or LDL, are bad cholesterol. Triglycerides, a major part of very low-density lipoproteins, can also raise heart disease risk.

Too much cholesterol can build up on the inner walls of your arteries and constrict the flow of oxygen-rich blood. That’s called atherosclerosis.

On the other hand, high-density lipoproteins, or HDL, are good cholesterol. HDL can pull LDL off arterial walls and sweep it away. High HDL levels give you protection against heart disease.

For years, the National Cholesterol Education Program (NCEP) has highlighted high LDL levels as a major risk factor for heart disease. People with other risk factors—such as smoking and obesity—were urged to maintain a low LDL.

The big difference between the NCEP’s old and revised guidelines is the emphasis on who needs to reach low LDL levels, says Dr. Smith.

Who is affected?
The new NCEP guidelines use a point system to determine your risk for heart disease. Your risk for heart disease determines your recommended LDL level. The difference between your actual and recommended LDL levels determines your treatment.

Since you’ll need to see your doctor to find out your current cholesterol levels and blood pressure, he or she can help you calculate your risk under the revamped guidelines.

For people whose cholesterol levels were previously considered OK, there are several ways your status might have changed, says Dr. Smith:

• If you have diabetes, you might be at the same high risk for heart disease as someone with a previous heart attack. Your target LDL level is less than 100 milligrams per deciliter (mg/dL) of blood.
• If you have two or more risk factors for heart disease, you might have moved from intermediate to highest risk. If so, your target LDL level is also less than 100 mg/dL. Major risk factors that affect your LDL goal are smoking, high blood pressure, HDL below 40 mg/dL, family history of early heart disease, and age (men 45 or older, women 55 or older).

There are two primary treatments used for lowering LDL:

• Lifestyle changes. This includes managing your weight, increasing physical activity and eating a low-fat, low-cholesterol diet.

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• Medication. There are cholesterol-lowering medications your doctor can prescribe. Medication is combined with lifestyle changes.

The revised cholesterol guidelines
The National Cholesterol Education Program recommends that everyone age 20 and older obtain a blood test called a fasting lipoprotein profile every five years. This measures total cholesterol, low-density lipoprotein (LDL), triglyceride and high-density lipoprotein (HDL) levels.

Classification of levels is as follows, measured in milligrams per deciliter of blood:

Total cholesterol
Less than 200: Desirable
200-239: Borderline high
240 or above: High

LDL
Less than 100: Optimal
100-129: Near optimal
130-159: Borderline High
160-189: High
190 or above: Very high

HDL
Less than 40: Low
60 or above: Protective

Triglycerides
Less than 150: Normal
151-199: Borderline high
200-499: High
500 or above: Very high

December 2002, Keystone Health Plan Central, Keeping Well