A national panel of experts had made recommendations on how to treat high cholesterol. Even those who have no symptoms could still be at risk for heart disease, which kills more than half a million Americans a year and is the number 1 killer of women.
The new guidelines, which were announced Tuesday in Washington, seek to address two problems: Not enough people know their cholesterol levels and those who do may not be treating the condition aggressively enough.
"It turns out that there are so many people who are at high risk that have not been identified before," says Dr. James Cleeman, the National Cholesterol Education Program coordinator. "[There's an] increase of people from 53 million to 65 million who need dietary changes and an increase from 13 million to 36 million who can be helped by drug therapy."
The guidelines call for all Americans to be screened for cholesterol and triglycerides at age 20, with the test repeated every 5 years. Doctors will be instructed to assess a patient's 10-year risk of heart disease and to lower LDL, or bad, cholesterol levels even further than they do now:
- To 160 or less for those with no to one risk factors.
- To 130 or less for two more risk factors.
- To 100 or less for those with heart disease diabetes and heart disease risk more than 20%.
The risk factors include
- High blood pressure.
- High cholesterol.
- Advancing age.
- A strong family history of cardiovascular disease.
The guidelines stress a high fiber, low-fat diet, which can include cholesterol-lowering plant stanols and sterols like those found in the margarines Benecol and Take Control. The board also advises 30 minutes of daily exercise.
But experts say patients with two or more risk factors should receive cholesterol-lowering statin drugs right away at the same time as lifestyle changes instead of taking a wait-and-see approach. The catch is, you likely have to take drug for rest of your life.
Some doctors say statins, which have also been shown to help prevent strokes and osteoporosis, are turning out to be wonder drugs.
"We are able to save lives and improve the quality of life and prevent events," enthuses Dr. Bassem-El Masri of Weill Cornell Medical Center.
An important change with these new guidelines is that women will now be treated as aggressively as men. In the past, doctors have often waited to prescribe statins for women. In clinical trails, the so-called super-statins have been shown to lower bad cholesterol by as much as 70%. Statin drugs are considered safe, with a 10-year history of study.
However, there is less data on patients over 65 so at-risk patients in that age group may be counseled to try diet and exercise first.
Ask your doctor about daily aspirin therapy.
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