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Why Americans' lower cholesterol isn't all good news

Cholesterol levels have gone down among Americans over the last 20 years, a new study finds, but there's still room for major improvements.

A study published in JAMA on Oct. 17 shows that the average total cholesterol for adults dropped from 206 mg/dL in 1988 to 196 mg/dL in 2010. Deaths from cardiovascular disease also dropped 31 percent during the same period.

However, cardiovascular disease still remains the leading cause of death for Americans. Also, some of the healthiest methods to lower cholesterol -- eating well and exercising - have been eschewed for cholesterol-lowering medication for many Americans.

Cholesterol is a fatty substance that naturally occurs and is necessary for the body to function. However, when you have too much of it, the buildup known as plaque can stick to the walls of your arteries and clog them.

Reconsidering HDL as a "good" cholesterol 01:50

There are two types of cholesterol: LDL (bad) and HDL (good). The American Heart Association recommends that people should have an optimal total cholesterol level of less than 200 mg/dL, with HDL cholesterol levels of 60 mg/dL or above. Optimal rares for LDL cholesterol are lower than 100 mg/dL. The ratio of your HDL to LDL should be below 5:1.

The study also showed that LDL cholesterol went down from 129 in 1988 to 116 in 2010. HDL cholesterol went up from 51 mg/dL to 53 mg/dL in that same time period.

The researchers say the improved statistics are possibly due to more Americans taking cholesterol-lowering medications known as statins. In 1988, only 3.4 percent of Americans were taking them. That number jumped to 15.5 percent. For those most at risk of high cholesterol, men and women over 50, the number of people taking statins went up 35 percent.

Cholesterol levels were also found to drop for adults not taking statins, suggesting that policies to remove trans fats from American foods may be working. In 2008, New York City banned the artificial fats from food items in city restaurants. A July 2012 study in Annals of Internal Medicine showed thatNew Yorkers have decreased their trans fat consumption as a result. The city is now working to ban sales of sugary drinks and soft drinks larger than 16 oz.

"We are hopeful that some of the increased awareness about diet may be paying off, but we still have quite a long way to go," Dr. Ralph Sacco, president of the American Heart Association and chairman of neurology at the University of Miami Miller School of Medicine, said to HealthDay.

Unfortunately, increases weren't seen in two important areas: overall diet and exercise. Saturated fat consumption has not went down in more than two decades, and more than two-thirds of Americans are overweight and obese, the authors noted.

"Cholesterol levels are just one measure of heart health," Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said to HealthDay. He was not involved in the study. "While cholesterol levels have significantly improved in the U.S. during this 1998-to-2010 time frame, other components of heart health -- such as maintaining a healthy body weight and participating in regular physical exercise -- have not."

Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic in Ohio who was not involved in the study, agreed. He told WebMD that the results should be taken with a grain of salt.

"The most likely and plausible explanation is that the decline in cholesterol is due to the more extensive use of medication in the at-risk population," Nissen said. "We are not moving more or getting lighter, and this didn't happen by accident."

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