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