NCEP issues new cholesterol guidelines

The National Cholesterol Education Program has issued new clinical practice guidelines on the prevention and management of high cholesterol in adults. The guidelines are the first major update from the NCEP in nearly a decade.

The NCEP, which is coordinated by the National Heart, Lung and Blood Institute, develops new guidelines as warranted by research advances. Earlier guidelines were issued in 1988 and 1993.

Key changes in the new guidelines are: more aggressive cholesterol-lowering treatment and better identification of those at high risk for heart attack; use of a lipoprotein profile as the first test for high cholesterol; a new level at which low HDL - high-density lipoprotein - becomes a major heart disease risk factor; a new set of "Therapeutic Lifestyle Changes" with more power to improve cholesterol levels; a sharper focus on a cluster of heart disease risk factors known as "the metabolic syndrome"; and increased attention to the treatment of high triglycerides.

The new guidelines are expected to substantially increase the number of Americans being treated for high cholesterol, raising the number on dietary treatment from about 52 million to about 65 million and increasing the number prescribed a cholesterol-lowering drug from approximately 13 million to about 36 million.

Reducing LDL

"Americans at high risk for a heart attack are too often not identified and, so, don't receive sufficiently aggressive treatment," said NHLBI Director Claude Lenfant. "Yet, studies show conclusively that lowering the level of low-density lipoprotein, or LDL, the 'bad cholesterol,' can reduce the short-term risk for heart disease by as much as 40%. Treatment may lower risk over the long term – that beyond 10 years – even more. That's why, while the intensity of treatment in [the new guidelines] is stepped up, its primary aim remains squarely on lowering LDL."

According to the guidelines, Americans at high risk for heart attack include those with heart disease or diabetes, and many of those with multiple heart disease risk factors. The guidelines state that diabetes poses as great a risk for having a heart attack in 10 years as heart disease itself – and the threat from multiple risk factors can be equally great. The guidelines recommend diabetics be treated as intensively as heart disease patients with lifestyle changes and medication.

To better identify risk, the guidelines include a tool that predicts a person's chance of having a heart attack within 10 years. Based on newly analyzed data from the landmark, NHLBI-supported Framingham Heart Study, the "risk assessment tool" translates clinical conditions and lifestyle factors into a single, easy-to-understand category of risk. The tool calculates risk separately for men and women based on age, total cholesterol, HDL (the "good" cholesterol), systolic blood pressure, treatment for high blood pressure and cigarette smoking. The new guidelines recommend the use of the tool for persons with two or more heart disease risk factors.

"The new guidelines will help doctors determine heart attack risk more precisely than was possible before," said Scott Grundy, director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas. "That allows treatment to be more individualized. We now know that cholesterol-lowering treatment is more effective when its intensity closely matches the level of risk."

"The [new] approach looks at 'overall' risk for a heart attack," said NCEP Coordinator James Cleeman, "which means in the short and long term. That's important because, although risk typically increases with age, the foundation for heart disease is often laid in adolescence and early adulthood. So Americans need to act now to prevent that future heart attack or heart disease itself. Every risk factor needs to be treated."

Cleeman advises Americans to check with their doctor to learn their overall risk for a heart attack and what, if any, treatment is needed. PR