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Doctors now want your cholesterol even lower, but how?

Estimated read time: 2-3 minutes

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If you have high cholesterol, you might feel like throwing up your hands when you hear that experts are now suggesting that some people reduce their LDL, or ''bad'' cholesterol, even lower than what doctors had been telling patients. nUSA TODAY reporter Rita Rubin answers some of the main questions you might have about the new report from the National Cholesterol Education Program:Q: What's different?

A: The report updates 2001 guidelines that set LDL goals of below 100 for high-risk people and below 130 for moderately high-risk people. (The U.S. average is 130.)

In addition, the update suggests lowering the point at which people should go on cholesterol-lowering drugs called statins.

The 2001 guidelines recommended that high-risk or moderately high-risk patients take medicine if their LDL was 130 or higher. The update suggests lowering the treatment bar to an LDL of 100.

Q: So how many Americans should be on cholesterol-lowering drugs?

A: The authors of the new report haven't done the math yet, but they estimate perhaps 40 million, up from the 36 million under the previous guidelines.

Q: Where does lifestyle fit in?

A: If you need to lower your LDL, the authors write, try a lot of TLC, or ''therapeutic lifestyle changes,'' such as quitting smoking, losing weight and exercising more. ''I don't think we should try to do this with drugs alone,'' says Sidney Smith, a University of North Carolina cardiologist.

It's not going to be easy, says cardiologist Ray Gibbons of the Mayo Clinic College of Medicine, who was not involved in writing the update. Lowering the LDL target to below 70 ''really puts an increased burden on the patients. It really makes patient compliance with lifestyle changes all that much more important.''

Q: Are these experts realistic?

A: If you have a pretty high LDL to begin with, getting below 70 may be an impossible dream, the authors say. But you should at least reduce your LDL by 30% to 40%, they write.

To accomplish that, you might need to take a higher dose of a statin or add another cholesterol fighter, such as nicotinic acid or special margarines, says James Cleeman, cholesterol education program coordinator.

Q: Is an LDL below 50 next?

A: Probably not, says Smith, a past president of the American Heart Association. In parts of the world where heart disease is practically unheard of, an LDL below 70 is pretty typical, he says.

The cholesterol program is awaiting the results of three more studies, expected over the next 18 months, before settling on a definitive number.

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© Copyright 2004 USA TODAY, a division of Gannett Co. Inc.


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