Heart Disease, Living Well with (cont.)
With regard to cholesterol, there are also studies now that are suggesting the lower the LDL or bad cholesterol levels, the better. The target for people with heart disease has been 100 milligrams per deciliter, a number that should be easy to remember.
A recent national expert panel from the National Institutes of Health (NIH) indicated that a target of 70 might be beneficial, but they labeled that an optional target, acknowledging that the evidence that we should go down that far is not yet definitive. These discussions in the medical community should not confuse the patient. There are far too many people who are not below the target level of 100, a level for which there is strong consensus. If a patient working with their doctor would like to be more aggressive and gamble that going to 70 would be even better, then there would be evidence to support them, even though the jury is not in yet.
In talking about fitness, I explain how physical activity can have a powerful effect on reducing risk and at the same time, provide considerable benefits with regard to quality of life and functioning. I urge people to think about fitness and weight as if they were a pill; that is, if these strategies were a pill, they would be miracle pills because of their abundance of benefits and virtual absence of side effects. Of course, making changes in lifestyle, which is really what is being suggested by these two strategies, can be challenging, but I tried to convey how their lives can be changed for the better.
C-reactive protein is a substance in the blood that indicates whether there is inflammation in the body and has turned out to be a good predictor of the risk of heart disease.
Now people are asking the question, can you lower risk by lowering CRP (C-reactive protein)? Some studies are suggesting that statin drugs, which are used to lower LDL cholesterol, may be useful in quieting inflammation and reducing the risk of heart disease. To this point, we lack a definitive study that proves the effectiveness of that strategy.
There is a large randomized trial that is currently underway in which patients with normal cholesterol levels, but elevated C-reactive protein levels, are being randomized to a statin drug or placebo. That study may help us understand whether the treatment of an elevated C-reactive protein should become, one day, a key strategy for the treatment of heart disease. But, for right now, it is uncertain whether treatment of C-reactive protein in that way is beneficial.
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