Body Shop
Lower cholesterol still not low enough

Cholesterol is a major risk factor for heart disease, and the lower it is, the better. Americans are making progress in lowering serum cholesterol levels. Forty years ago, the average cholesterol level was about 225 mg/dl. That's high! Today the average has dropped to about 205.

But that's still high, and lowering cholesterol at the rate of a half-point a year is an incredibly low rate of progress. We can do much better. New guidelines give us a much needed nudge in the right direction.

Perspective

Before 1987 the upper limit for a normal cholesterol level was 300 mg/dl. Anything lower than 300 was considered to be OK, leaving millions of Americans walking around with dangerous levels of cholesterol, oblivious to the implications.

Finally, after years of struggle, a group of concerned health professionals exerted enough pressure to get the National Heart, Lung and Blood Institute to issue a new set of guidelines. They weren't satisfactory, but at least they were a step in the right direction.

According to the 1987 guidelines, a cholesterol level below 200 was considered to be healthy. The 200-240 range was a gray zone, and red flags didn't go up until your cholesterol exceeded 240. These guidelines were adopted even though the Framingham Heart Study (ongoing since 1949 and the primary source of information regarding lifestyle and heart-disease risk) demonstrated clearly that a 200 cholesterol level is still dangerously high and that only when cholesterol dips below 150 can you put a label of "healthy" on it.

Why didn't we have good guidelines in 1987? I suspect there were a number of compromises that altered the outcome.

It's obvious that many industries would oppose any effort to overhaul cholesterol guidelines. That's because lowering cholesterol requires consuming much less fast food, red meat, fatty dairy products, snack foods, etc. Less consumption means less profits. With much to lose, these powerful industries can exert considerable clout.

The right direction

The new guidelines take another step in the right direction. How did we gain enough momentum to take that step? It's hard to say, but I suspect the new guidelines have a powerful ally.

We have a number of powerful medications that help knock cholesterol way down, and the lower cholesterol goes, the lower the risk of heart disease. With lower guidelines to shoot for, more people become candidates for medication. Thus, more profits for pharmaceutical companies.

This sounds like a harsh indictment, I know, but regardless of the source, I'm delighted at the progress. Besides, after you have done everything you can to lower your cholesterol, I do favor the use of medications to reduce it even further.

The new guidelines emphasize lowering LDL cholesterol, the kind that contributes to clogging of the arteries (atherosclerosis). LDL is only one component of total cholesterol, and when using LDL it's confusing trying to reference the newest guidelines against former guidelines because the old guidelines didn't single out LDL. But I'll try to simplify things.

According to the new guidelines, a desirable LDL is 100 mg/dl or less. The gray zone is 100-129; above 130 is red-flag territory.

To get an idea of how this relates to total cholesterol, you would have to add the other components to the LDL figure. The average HDL cholesterol (the good type of cholesterol that helps combat clogging) for men is about 42 mg/dl; for women it's about 52. The average VLDL, another component of cholesterol, is about 30 for both men and women.

Bear in mind that these are gross averages and may vary widely. At any rate, putting things in this perspective suggests that a desirable total cholesterol for men would be in the neighborhood of about 172 mg/dl (100 plus 42 and 30) and 182 mg/dl for women (100 plus 52 and 30). The gray zone would extend to about 200 for men; the red-flag zone would begin at levels higher than 200.

This is clearly a step in the right direction, though these guidelines did not go far enough.

Some good news

Let me now praise the guidelines for finally including an invaluable feature. The new LDL cholesterol values are considered in concert with other risk factors. This means that if I smoke, have high blood pressure, a low HDL, a family history of heart disease, excess abdominal obesity, or am older than 45 (men) or 55 (women), the guidelines are interpreted more strictly. In other words, your doctor is encouraged to be more aggressive in treating you.

This is a critical feature, because we have known for decades that the impact of any given level of cholesterol is influenced strongly by other risk factors.

The bottom line

Being healthy is a low priority in this country. If you doubt this, take a look around.

Although we still have a long way to go, at least we appear to be moving in the right direction, and the new guidelines are a helpful step.

Bryant Stamford is an exercise physiologist and director of the Health Promotion and Wellness Center at the University of Louisville. If you have questions about sports injuries, health, exercise or fitness, write to Body Shop, Gannett News Service, care of The Courier-Journal, 525 W. Broadway, P.O. Box 740031, Louisville, Ky. 40201-7431, or e-mail bryant@louisville.edu.