The New Cholesterol Challenge

A healthy lifestyle is crucial, but stricter limits for 'bad' cholesterol may require many more to take drugs

Health & Fitness

July 25, 2004|By Elizabeth Large | Elizabeth Large,Sun Staff

On the day after new recommendations on cholesterol levels made front-page news, a few fitness buffs were working out at the Downtown Athletic Club on their lunch hour. An informal sampling showed that they knew a lot about exercise and a healthy diet, but were a little shakier when it came to their blood-cholesterol levels.

Harry Altscher, 57, a lawyer who lives in Ellicott City, stopped for a minute to towel off the sweat and admit that he didn't know what his LDL, or harmful cholesterol, is. This is the figure that some researchers now believe can't be too low for a healthy heart.

But Altscher isn't sure. "I'm not fully convinced cholesterol does as much damage as they say if you have the right lifestyle," he said. "I'm just not a pill person. Maybe I'll load up on oat bran." Besides, he added, 20 years later new reports always seem to come out that contradict the old research.

Richard Baker, 44, a waiter, was leaning on an exercise machine nearby. He has one of the significant risk factors for cardiovascular disease -- his father died of a heart attack at a relatively early age. Still, when Baker, who lives in Cedarcroft, went to his doctor recently, all he learned was that his total cholesterol was 203 and his HDL (the good cholesterol) was high.

Gerald Popko, 50, was doing bicep curls with a slow, rhythmic motion while he explained he's already on the cholesterol-lowering drug Lipitor. He was the only one who knew his LDL: 120 milligrams per deciliter.

"My doctor told me it's the lowest he's ever seen," said the Roland Park hairdresser.

We have bad news for you, Gerald. And Harry and Richard.

Under the new recommendations, endorsed by the National Institutes of Health and the American Heart Association, patients at high risk of heart attack or stroke should get their LDL under 70 -- a number difficult to reach without using large doses of cholesterol-lowering drugs. In government guidelines published just a couple of years ago, the figure was 100. That's now the goal for those at moderately high risk, which was previously 130.

Panelists criticized

Backing up these new recommendations, published July 13 in the journal Circulation, are data from five major clinical trials of statins, the most commonly used cholesterol-lowering drugs. From the beginning, the findings were controversial. Some experts worried that the importance of lifestyle changes in preventing cardiovascular disease would get lost in the emphasis on drugs. About 7 million more Americans could find themselves on statins, already the most prescribed medicines in the United States.

Much of the funding for the clinical trials came from the very companies that make these drugs, but researchers say that did not influence the results. More worrisome to some consumer groups, most of the heart disease experts on the panel that wrote the new recommendations received consulting or speaking fees or other support from manufacturers of statins.

So what does this mean for you?

Maybe not much. Not every doctor is planning to put more of his or her patients on higher doses of drugs -- yet. Dr. Roger Blumenthal, director of the Johns Hopkins Ciccarone Preventive Cardiology Center, thinks that getting patients' LDL levels below 100 is "still a reasonable clinical strategy." He still feels lifestyle factors such as diet and exercise are the "cornerstone."

But if nothing else, the recommendations are further evidence that lowering your level of harmful cholesterol is a good idea, whether you are at high risk or low risk for cardiovascular disease. After all, for a third of the people who have a heart attack, their first symptom is their last. In other words, they're dead.

But what price a low LDL? Statins are expensive drugs. If you don't have a prescription plan, you could spend around $100 a month. (Of course, no one's arguing that having a heart attack isn't costly.)

Dr. James Richardson at Union Memorial Hospital treats elderly patients who often don't have drug insurance. They tell him, "as long as you can give me samples, I can take it."

"I am concerned patients will resist upping the dosage," he said. His patients also sometimes stop taking statins -- without telling him -- because the drugs can cause muscle pain in their arms and legs. These are people who have arthritis anyway. "Studies have shown that it's one thing to hand patients a prescription, another to get them to fill it."

Elmer Stump, 68, a Timonium project manager, falls in the "very high risk" category because he had a heart attack a decade ago. When he was told the new recommended goal for people like him was under 70, he sounded stunned. "Oh, my god. Everyone who has high cholesterol says there's no way you can get it below 100."

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