American Heart Association's New Guidelines

VIRGINIA ANDERSON, Staff

Posted July 14, 2004

Levels of what is commonly called "bad" cholesterol need to be lower for millions of Americans, with a new goal of 70 for those at very high risk of heart disease.

New guidelines published Monday by the American Heart Association may mean that many Americans need to dramatically change their diet and exercise routines, as well as take cholesterol-lowering drugs, doctors said Monday. The previous goal for bad cholesterol was 100 or less.

"We still must emphasize that Americans need to make lifestyle changes," said Dr. Sidney C. Smith, professor of medicine at the University of North Carolina and a former president of the American Heart Association. "We have to emphasize the right lifestyle. We can't depend on drugs alone to solve this problem."

About 7 million people at very high risk for heart disease will be most affected by the guidelines --- people who have had previous heart attacks or who have coronary artery disease and diabetes.

The guideline changes also will affect about 30 million other Americans who are considered to be at high risk.

The change in the cholesterol goal could mean treatment for such risks will be "intensified," said lead author Dr. Scott M. Grundy, the director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center in Dallas. Intensifying treatment could mean adding exercise, changing diet or switching drugs.

The first new guidelines on cholesterol since 2001, while not a surprise, came earlier than many cardiologists had expected. A panel of the National Cholesterol Education Program has been assessing new studies for several months to determine whether a change was needed.

Over the last three years, five clinical trials involving more than 50,000 patients have shown success in preventing heart attacks by lowering bad cholesterol in high-risk patients.

"It became a little more urgent," said Grundy. Three more clinical trials on the benefit of lowering cholesterol are still under way. Some on the panel questioned whether the group should wait for the results of those studies.

"But the question was, how long do we wait?" said Smith at UNC.

The American College of Cardiology and the National Heart, Lung and Blood Institute joined the National Cholesterol Education Program in endorsing the new rules Monday.

The recommendations have not changed for those in the lower to moderate risk categories. Those in the low risk category should be keeping their LDL, or bad cholesterol, level at 160 or lower. Moderate risk patients should be keeping it at 130 or lower.

While the new rules will no doubt boost the sale of statins --- powerful, cholesterol-reducing drugs --- patients will also need to make serious lifestyle changes. "Our lifestyle choices, on average, are a disaster," said Dr. Laurence Sperling, chief of preventive cardiology at Emory University School of Medicine.

"The average person is going to need to do more to get to [the new LDL] goal," he said. That will mean eating more fiber, fish, soy and fish oil, Sperling said. Date: July 13, 2004

Copyright 2004 The Atlanta Journal-Constitution