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National cholesterol guidelines
that are expected to help more Americans lower their risk of heart disease
will boost the number of people eligible for cholesterol-lowering medication
by 140%.
Their analysis indicates that
the guidelines could triple the number of people younger than 45 who can
take medication and increase
the number of older Americans eligible for the drugs by about 130%.
The costs of the drugs coupled
with a lack of a national drug prescription benefit program could
force some older individuals to choose between taking the drugs and buying
food.
We have to look at the consequences.
There is a large number of people being prescribed very expensive medication
and we've had a limited number of years with the drugs.
The guidelines,
released last year by the National Cholesterol Education Program (NCEP),
a division of the National Institutes of Health, replace those set in
1993. Now, patients with LDL ("bad") cholesterol of 130 milligrams
per deciliter (mg/dL) of blood in addition to two risk factors for heart
disease are eligible for medication. The previous guidelines set a threshold
of 160 mg/dl plus two other risk factors.
People with high cholesterol
are at risk of developing 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 and type 2 diabetes.
The updated recommendations
stress that diet with exercise is still the first-line of treatment for
high cholesterol. But most people will fail to make the lifestyle changes
necessary to lower their risk of heart disease and many will turn to the
drugs for help.
The more recent recommendations
qualify
36 million Americans for drug therapy, of whom
nearly one-third are younger than 56, and more than one-quarter are older
than 65. About 55% of those eligible are men.
Under the old guidelines, 15
million people aged 20 to 79 were eligible for cholesterol-lowering drugs.
Among other changes, the guidelines
now recommend an even lower intake of saturated fat, a higher blood level
of HDL ("good") cholesterol and more rigorous testing of fatty
substances in the blood.
Circulation January 15,
2002;105
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