New federal guidelines for managing cholesterol issued in the US will increase the number of Americans who are treated for high cholesterol -- either by diet or drugs -- by roughly 36 million.

Among other changes, the guidelines now recommend

• an even lower intake of saturated fat
• a higher blood level of HDL, or "good" cholesterol
• more rigorous testing of fatty substances in the blood (triglycerides)
  

People with high cholesterol are said to be at risk for heart disease, the leading cause of death in the US.

About 500,000 Americans die of heart disease each year. Other risk factors include

• smoking
• excess weight
• a sedentary lifestyle
• type 2 diabetes
  

The guidelines update the previous recommendations made in 1993. The new recommendations still focus on lowering LDL, or "bad" cholesterol, with a level below 100 milligrams per deciliter of blood (mg/dL) still considered ideal.

However, the guidelines include a change in the recommended level of HDL or "good" cholesterol. Now an HDL level of less than 40 mg/dl is considered to be a risk factor for heart disease, as opposed to 35 mg/dl

The guidelines also place greater emphasis on triglycerides, another fatty substance in the blood. The guidelines recommend that doctors urge patients whose triglyceride level is borderline to lose weight and exercise.

Healthy adults should also have a lipoprotein analysis, which measures triglycerides, total cholesterol, LDL and HDL cholesterol once every 5 years. Previously, a screening test that looked only at total and LDL cholesterol was advised.

Recommendations include:

• Patients should consume no more than 7% of calories from saturated fat rather than the previous recommendation of 10%.
  

• Adults are advised to consume no more than 35% of calories from total fat, up from the previous recommendation of 30%, provided that the main source is unsaturated fat, which does not raise cholesterol levels.

• The new target for cholesterol is less than 200 mg a day versus the previous target of under 300 mg.

The soluble fiber found in cereal grains, beans, peas, legumes, and fruits and vegetables may help to lower cholesterol level, and exercising and maintaining a healthy body weight have been shown reduce LDL cholesterol and boost HDL cholesterol levels.

Women are advised against choosing hormone replacement therapy (HRT) as a replacement for cholesterol-lowering drugs. According to the NHLBI, HRT does not appear to lower the risk for a major heart attack among postmenopausal women with heart disease and may increase the risk of stroke.

Overall, the guidelines mean that 65 million Americans should make dietary changes to lower cholesterol, up from 52 million who are now candidates, and 36 million should be taking cholesterol-lowering drugs, compared with 13 million who are prescribed the drugs.

The Journal of the American Medical Association May 16 2001;285:2486-2497

Dr. Mercola's Comments:

OK, here we go again. Now the "experts" have raised the ante. They changed the "normal" range so even more people will be put on cholesterol lowering drugs. Prior to the new recommendations 13 million Americans "qualified" to be placed on these drugs. With these new recommendations 36 million Americans now qualify -- nearly triple the amount. After all, that is the answer, isn't it? If people can't lower their cholesterol by following the low-fat nonsense then they need to take these drugs to prevent them from falling prey to the number one killer in the US, heart disease. Hogwash. Nothing could be further from the truth. If you have been receiving the newsletter for some time you will be familiar with my position on this issue. If not, I would encourage you to study the links below. About one year ago the experts predicted that HALF the population will be taking these types of drugs. The big issue here is that these potent medications will be over the counter in the near future with a massive PR campaign to encourage people to swallow these potentially dangerous drugs. The amazing thing about these new recommendations is that they completely ignore the previously published evidence that are quite clear in documenting that the actual cholesterol level itself is not the most important risk factor. It is actually the ratio between the level of total cholesterol and HDL. The ideal HDL/cholesterol ratio should be higher than 25% and generally speaking the higher the better. The ideal triglyceride/cholesterol ratio should be below 2.0. If you did not know any better and just listened to the "experts" you would think cholesterol is an evil substance and that most of us would benefit from lowering our cholesterol as low as possible. Not so. Cholesterol is a vitally important substance that is responsible for building our cell membranes and many of our hormones. If the level drops to low we are actually at increased risk for depression. There are likely to be some people who benefit from them, but it is probably far less than 5% of the people who currently take them. These are individuals with total cholesterol above 350 who have inherited liver processing problems. If these individuals take the statin drugs however, they should also take Coenzyme Q10, which is important for heart health and, like cholesterol, is reduced when one takes these drugs. The proper way for nearly everyone else to control their cholesterol levels is by reducing their grain intake by following the food choice program I recommend. Another problem is the fact that low cholesterol is associated with numerous problems, as you can see from some of the studies below. Related Articles: Cholesterol Drugs: How Expensive Is Too Expensive? Cholesterol Lowering Drugs Suppress Immune System Low Cholesterol Causes Aggressive Behavior Low Cholesterol Linked to Stroke Risk Low Cholesterol Linked to Depression Low Cholesterol Linked to Violence