Doctors group calls for even lower LDL

Recommendation applies to `bad cholesterol' for people at highest risks

July 13, 2004|By Delthia Ricks | Delthia Ricks,NEWSDAY

In recent years, doctors have been repeating like a mantra that lower is better when it comes to the bad form of cholesterol, and yesterday they officially recommended the lowest possible levels for people most likely to have a heart attack or sudden cardiac arrest.

The new recommendations for those at high risk call for dropping the bad form of cholesterol - LDL - to 70 milligrams per deciliter of blood or lower, down from the prior recommendation of 100.

The guidelines also call for more aggressive use of statins, such as Lipitor, capable of preventing formation of plaque in the arteries by inhibiting formation of LDL by the liver.

Recommendations for people at low risk are unchanged.

"This is about saving more lives," said Dr. Scott Grundy of the University of Texas Southwestern Medical Center in Dallas, chairman of the panel that developed the new rules.

Several major studies had drawn the conclusion that lower is better, but only now, Grundy said, is the evidence available to make a broad recommendation to the public.

Grundy led the Adult Treatment Working Group of the National Cholesterol Education Program, which decided the new strategy would best help people who have already had heart attacks and those with a 10 percent to 20 percent chance of heart attack or sudden cardiac death within 10 years.

Grundy and the other panelists also emphasized the importance of maintaining a healthy diet, being active and breaking the cigarette habit.

The cholesterol education program, created in 1985 by the National Heart, Lung and Blood Institute, was designed to educate doctors and the public about the benefits of reducing cholesterol to minimize the risk of coronary artery disease.

People at highest risk are those who have had a heart attack or the chest pain known as angina plus one or more of the following: they smoke, have diabetes or have undergone angioplasty or bypass surgery.

Moderately high-risk people - who might have many of the same risk factors but have slightly lower LDL - are estimated to have at least a 10 to 20 percent chance of a heart attack within 10 years.

"There have been many studies going back for many years showing that in certain populations, people who had the lowerst cholesterol levels had the fewest heart attacks," Grundy said. "In China and other places where people have very low cholesterol levels, there is a very low rate of heart disease. That is part of what has led us to believe that lower is better."

Reported in today's issue of Circulation, a publication of the American Heart Association, the guidelines update the working group's rules released in 2001.

The revised recommendations announced yesterday reflect conclusions drawn from five major clinical trials conducted nationally since 2001. All demonstrated that patients became healthier when their LDL was especially low.

Grundy said some people might need combination therapy - a statin drug and another type of medication that prevents the absorption of fats from the small intestine.

Newsday is a Tribune Publishing newspaper.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.