New US cholesterol guidelines are strictest ever

1.00pm

WASHINGTON - New US cholesterol guidelines issued on Monday set the lowest level yet for high-risk patients, with recommendations for aggressive use of drugs to get levels down.

The new recommendations also stress no patient should rely on drugs alone to lower cholesterol, but should also take responsibility for the right diet and exercise to keep the heart and arteries healthy.

Although patients were once told to get so-called bad cholesterol down to about 100, the new guidelines say the highest-risk people need to aim for a low-density lipoprotein level of 70.

"The lower the better for high-risk people," Dr Scott Grundy, who chaired the National Cholesterol Education Programme panel that wrote the guidelines, said in a statement.

"That's the message on bad cholesterol -- low-density lipoprotein (LDL) cholesterol -- from recent clinical trials," added Grundy, director of the Centre for Human Nutrition at the University of Texas Southwestern Medical Centre at Dallas.

The new guidelines, published in the American Heart Association journal Circulation, will be good news for drug companies that make statins and other cholesterol-lowering drugs.

For high-risk people -- who have had a heart attack, diabetes, chest pain, or surgery to clear blocked blood vessels -- the recommendation is to medicate everyone with LDL above 100.

Smokers with heart disease, or patients whose blood pressure is not well controlled, and those considered close to developing diabetes based on blood sugar levels, are also advised to get LDL cholesterol down to 70.

Those considered at moderate risk have multiple risk factors giving them a 10 to 20 per cent chance of heart attack or cardiac death within 10 years. They are now being told to take drugs if their LDL is 130 or above.

Recommendations for treatment in people at lower or moderate heart risk are unchanged.

The new guidelines also note older people should be treated too.

"Although the update suggests that physicians use their clinical judgment to determine whether intensive LDL-lowering therapy is warranted in older persons, these people should not be excluded from the benefits of LDL-lowering treatment just because of age," said Dr James Cleeman, who organises the NCEP.

Grundy noted the drugs should not be prescribed without advice to exercise and eat more fruits, vegetables and fibre and less fat.

"The idea that you can use cholesterol-lowering drugs without lifestyle changes is incorrect," Grundy said. "Lifestyle changes have enormous benefits beyond lowering LDL cholesterol, such as raising levels of good cholesterol, lowering triglycerides, improving diabetes, and reducing inflammation."

The new guidelines are based on a review of five major clinical trials of statin drugs conducted since 2001. They are endorsed by the National Heart, Lung, and Blood Institute, the American College of Cardiology, and the American Heart Association.

"These trials show a direct relationship between lower LDL cholesterol levels and reduced risk for major coronary events," said NHLBI acting Director Dr Barbara Alving.

- REUTERS