Americans take Cholesterol advice to heart

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Americans appear to be taking the advice about lowering their blood cholesterol levels to heart.

According to the National Center for Health Statistics (NCHS), significant reductions in the blood cholesterol levels of U.S. adults have occured during the last 12 years. Average cholesterol levels in the U.S. dropped nearly four percent between 1978 and 1990 among every age/sex group studied.

Moreover, the proportion of Americans with "high" cholesterol levels dropped from 26 to 20 percent, while the number of adults with "desirable" cholesterol levels increased from 44 to 49 percent.

Yet some 52 million Americans still have cholesterol levels that exceeded health recommendations, prompting release of another report in June from the National Cholesterol Education Program's (NCEP) Expert Panel on the Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (ATP II).

The new report updates ATP I guidelines published in 1988, but continues several themes: namely that high levels of low density lipoproteins, or LDLs, are the main targets for therapy; dietary therapy is the first line of treatment; and drug therapy is reserved for the highest risk patients.

But according to Scott M. Grundy, M.D., ATP II chairperson and director of the Center for Human Nutrition, University of Texas Southwestern Medical Center, "The new report also reflects our improved understanding of cholesterol and its lipoproteins, and makes some key changes."

Among them are recommendations for more aggressive therapy in patients with existing heart disease. The patient's age and sex also should be considered when prescribing therapy, recognizing that an older person has a much higher risk than a younger person.

Moreover, the new report recognizes the benefits of high density lipoproteins (HDL) levels, or good cholesterol believed to protect against heart disease. HDLs should be routinely checked, together with total cholesterol. HDLs higher than 60 mg/dL should be considered a negative risk factor. "In other words," Grundy explained, "a high HDL reduces the risk of coronary heart disease, and it should lessen the need for very aggressive therapy in patients having high HDL levels."

Greater emphasis is placed on weight loss and physical activity as essential components of dietary therapy. Studies show that increased activity and weight loss by those who are overweight significantly decrease illness and death in heart disease patients.

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