Should you lower your cholesterol?


If you have coronary heart disease, you may want to consider lowering your cholesterol levels--even if those levels are considered normal.

Two recent studies have found that people with heart disease who lower their cholesterol levels significantly reduce their risk of heart problems regardless of whether their original cholesterol levels were considered high. Previous studies have found similar benefits in people with heart disease and high cholesterol levels.

In the first study, reported in the Oct. 3, 1996, New England Journal of Medicine, researchers assigned 4,150 heart attack survivors with total cholesterol levels below 240 milligrams (mg) per deciliter (dl) to receive either pravastatin (Pravachol) or an inactive placebo. Those who received the cholesterol-lowering drug were 24 percent less likely to have a second heart attack or to die from coronary heart disease than those who took the placebo. They were also 26 percent less likely to need bypass surgery, 23 percent less likely to require balloon angioplasty and 31 percent less likely to suffer a stroke.

In the second study, reported in the Oct. 1, 1996, Annals of Internal Medicine, 91 people with coronary heart disease and normal cholesterol levels were given a combination of pravastatin and either nicotinic acid (a form of the vitamin niacin) or gemfibrozil (Lopid), another cholesterol-lowering drug. These drug combinations enabled them to maintain target levels of low-density lipoprotein (LDL), the so-called bad cholesterol, to increase levels of high-density lipoprotein (HDL), the so-called good cholesterol, and to lower levels of triglycerides.

The participants in this combination therapy trial were able to reduce their LDL levels to 100 mg/dl or below--the National Cholesterol Education Program's goal for people with heart disease. The participants in the pravastatin trial were able to reduce their LDL levels from an average of 139 mg/dl to an average of 97 mg/dl.

According to the National Cholesterol Education Program, LDL levels should be less than 130 mg/dl and less than 100 mg/dl in people with heart disease. Levels between 130 and 159 mg/dl are considered borderline high, and levels 160 mg/dl or above are considered high. Total cholesterol levels should be less than 200 mg/dl. Levels between 200 and 239 mg/dl are considered borderline high, and levels 240 mg/dl or higher are considered high. HDL levels should be 50 to 75 mg/dl or higher. Levels between 35 and 49 mg/dl are considered borderline low, and levels less than 35 mg/dl are considered low.

The findings of these two studies indicate that cholesterol levels should be treated more aggressively in people with heart disease than in people without heart disease, according to Basil Rifkind, M.D., a senior scientific advisor at the National Heart, Lung and Blood Institute. Rifkind estimates that 60 to 70 percent of people with heart disease should use some type of cholesterol-lowering drug therapy (Medical Tribune, Nov. 7, 1996).

Bear in mind, however, that a study reported in the Nov. 2, 1994, Journal of the American Medical Association indicates that high cholesterol levels do not place people older than 70 at increased risk of death or hospitalization from heart disease.

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