Americans' cholesterol levels show improvement Weight loss, exercise, diet changes urged

June 16, 1993|By New York Times News Service

WASHINGTON -- Blood cholesterol levels among adults dropped significantly over 12 years, and about half of all Americans now have readings in the desirable range, experts said today.

Results from a new national health survey showed a 4 percent decline in the average cholesterol level, from 213 milligrams per deciliter of blood in 1978 to 205 milligrams in 1990. A level below 200 milligrams is considered desirable. The survey also found that the proportion of adults with very high blood cholesterol levels fell to 20 percent from 26 percent.

But levels of cholesterol, which are a factor in heart disease, remain high enough that the National Heart, Lung and Blood Institute issued aggressive new guidelines for the detection, evaluation and treatment of high blood cholesterol in adults.

They put new emphasis on adding exercise and weight loss to dietary changes to reduce the intake of fat and cholesterol.

The recommendations also call for delaying the use of cholesterol-reducing drugs for most younger adult men and premenopausal women who have a low risk for developing heart disease, but more aggressive use of the drug therapy among those who already have heart disease or who have failed to lower cholesterol with dietary changes.

Results of the health survey, being published on Wednesday in the Journal of the American Medical Association along with the new guidelines, show that the public has been heeding the advice of health agencies and doctors to reduce cholesterol levels, experts said.

Dr. Claude J. Lenfant, director of National Heart, Lung and Blood Institute, a division of the National Institutes of Health, told a news briefing that the decline in cholesterol levels was "heartening" but pointed out that coronary heart disease was still the nation's leading killer, striking down 500,000 Americans a year.

Dr. Manning Feinleib, director of the National Center for Health Statistics, said early statistics taken from his agency's third National Health and Nutrition Examination Survey, conducted from 1988 to 1991, showed a sharp drop in average blood levels of cholesterol, a fatty substance that contributes to the clogging and hardening of blood vessels.

The results are based on medical examinations of almost 8,000 people selected to represent the adult population.

From 1978 and 1990, Dr. Feinleib said at the briefing, the proportion of adults with high levels of 240 or above fell to 20 percent from 26 percent. The proportion with desirable blood cholesterol levels rose to 49 percent from 44 percent.

The latest findings continue a trend of dropping cholesterol levels over the last 30 years, he said, but more than half the total decline occurred in the last 12 years surveyed, he said.

The drop in blood cholesterol seen recently occurred in that fraction of the fatty substance known as low density lipoprotein, or LDL, the bad form of cholesterol, the survey found.

The LDL decline can be attributed to numerous factors, including changes in the consumption of fats, more physical activity, the use of lipid-lowering drugs and decreased obesity, Dr. Feinleib said.

The survey found that the average cholesterol levels for Mexican-Americans was 202 for men and 200 for women, and the averages for blacks was 199 for men and 203 for women.

Cholesterol levels in both groups were significantly lower than those for whites, which were 206 for men and 208 for women, and Dr. Feinleib attributed this in part to the white population being older, on average, than the other groups. Cholesterol levels tend to rise with age.

Statistics from the health survey proved useful to a panel of experts who revised guidelines issued by the National Cholesterol Education Program on the testing, evaluation and treatment of high blood cholesterol in adults, said Dr. Scott M. Grundy, chairman of the revision committee.

Dr. Grundy, director of human nutrition at the University of Texas' Southwestern Medical Center at Dallas, said the new recommendations were more aggressive than those released in 1988.

Among the new recommendations are these:

* Place more emphasis on changes in diet, particularly cutting total dietary fat and reducing saturated fat intake, in combination with physical exercise and weight loss, as the first line of treatment for high cholesterol.

* Delay use of cholesterol-lowering drugs as long as possible, choosing drug therapy only when it is indicated by the patient's coronary heart disease status and other risk factors. Use of these drugs should be postponed particularly in the cases of most young adult men and pre-menopausal women who have otherwise low risks for heart disease.

* Measure high-density lipoprotein cholesterol, the "good" cholesterol, at the same time that total cholesterol measurements are taken during a routine visit to a doctor. All adults over age 20 should be retested every five years.

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