There has been remarkable progress, in recent years, in the study of heart disease. Substantial advancements have been made related to the impact that cholesterol has on the disease. There is convincing evidence that lowering cholesterol ratio decreases the incidence of cardiac events in individuals with and those without heart disease. Greater emphasis is placed on the importance of diet, cutting down on high cholesterol foods & lifestyle changes like regular exercise.
These advances in research have led the National Cholesterol Education Program (NCEP), (a group of the nation’s leading cholesterol experts, coordinated by the National Heart, Lung, and Blood Institute), to issue new guidelines on the prevention and management of high cholesterol in adults. The guidelines are an update of the clinical practice guidelines issued in 1988 and 1993.
Unlike NCEP’s earlier guidelines, which focused on an individual’s total cholesterol, the new guidelines stress the importance of reducing levels of LDL (low-density lipoprotein or the so-called "bad cholesterol"). The new guidelines were based on studies that have shown conclusively that lowering "bad cholesterol" (LDL) can reduce the short and long-term risk for heart disease.
Key changes in the new guidelines include:
1. More aggressive treatment for lowering cholesterol and better identification of those at risk for heart attack.
According to NCEP, individuals at risk for heart attack are those who have heart disease or diabetes and those with multiple heart disease risk factors. The guidelines recommend that these individuals be treated aggressively with lifestyle changes and medication.
To better identify those at risk for heart attack, the guidelines include a formula that predicts a person’s chance of having a heart attack within the next ten years. The formula calculates risk separately for men and women and factors in age, total cholesterol, HDL ("good cholesterol"), blood pressure, treatment for high blood pressure, and cigarette smoking.
2. Using a lipoprotein profile as a first test for high cholesterol.
A lipoprotein profile measures levels of LDL ("bad cholesterol"), total cholesterol, HDL ("good cholesterol"), and triglycerides (another fatty substance in the blood). Previously, only measurements of total cholesterol and HDL were recommended. The new guidelines advise adults over age 20 have a lipoprotein analysis once every five years.
3. An increase in the amount of "good cholesterol" that a person needs.
HDL ("good cholesterol") protects against heart disease. The new guidelines define a low HDL level as being less than 40 mg/dL (a change from the previous low of 35 mg/dL). A level of less than 40 mg/dL is considered a major risk factor because it increases a person’s risk for developing heart disease. A HDL level of 60 mg/dL or higher helps to lower one’s risk for heart disease.
4. Greater emphasis is placed on the importance of diet, exercise, and weight control in the treatment of high cholesterol.
Saturated fat and cholesterol in the food we eat makes cholesterol levels go up. The new guidelines call for limiting saturated fat in the diet to 7% of total calories per day (previously, it called for a 10% limit). The guidelines also encourage eating certain foods that contain stanols and sterols, and foods that are rich in soluble fiber, to lower LDL ("bad cholesterol") levels. Plant stanols and sterols are found in certain margarines and salad dressings. Foods high in soluble fiber include cereal grains, beans, peas, legumes, and many fruits and vegetables.
The guidelines also stress the need for weight control and physical activity, both of which reduce the risk of heart disease.
5. Increased attention on "metabolic syndrome" as a strong contributor to heart disease.
Metabolic syndrome is characterized by having high blood pressure, elevated triglycerides, insulin resistance, and a low HDL level. Its classic symptom is too much fat around the middle (an "apple" body shape). The guidelines stress the importance of recognizing this syndrome and treating it with changes in diet and exercise.
6. More aggressive treatment for those with elevated triglycerides.
Triglycerides can also increase the risk of heart disease. The new guidelines recommend treating those with borderline-high triglyceride levels as well as those with elevated levels. Treatment includes weight control, exercise, and in some instances, medication.
The new guidelines, which were developed over a 20-month period, are a real step forward in the battle against heart disease. They stress that to truly combat this disease we must identify and treat, not only those with heart disease, but also those at greatest risk.
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