Your Cholesterol Profile - In Depth (cont.)
How can LDL cholesterol levels be lowered?
In order to lower LDL cholesterol, the activity level of the LDL receptors
must be increased. LDL receptor activities can be increased by diets that are
low in cholesterol and saturated fats and by medications.
Therapeutic lifestyle changes to lower cholesterol
Lowering LDL cholesterol involves losing excess weight, exercising regularly,
and following a diet that is low in saturated fat and cholesterol. (Please visit
the Therapeutic Lifestyle Changes (TLC) section
(http://www.nhlbi.nih.gov/chd/lifestyles.htm) for more detailed information on
diet and exercise to lower blood cholesterol.)
Medications to lower cholesterol
Medications are prescribed when lifestyle changes cannot reduce the LDL
cholesterol to desired levels. The most effective and widely used medications to
lower LDL cholesterol are called statins. Most of the large controlled trials
that demonstrated the heart attack and stroke prevention benefits of lowering
LDL cholesterol used one of the statins. Other medications used in lowering LDL
cholesterol and in altering cholesterol profiles include nicotinic acid
(niacin), fibrates such as gemfibrozil (Lopid), resins such as cholestyramine
(Questran), and ezetimibe, Zetia. (An in-depth discussion of these drugs is
presented in this article starting at the heading: What are the statin drugs?)
What are "normal" cholesterol blood levels?
There are no established "normal"
blood levels for total and LDL cholesterol. In most other blood tests in
medicine, normal ranges can be set by taking measurements from large number of
healthy subjects. For example, normal fasting blood sugar levels can be
established by performing blood tests among healthy subjects without diabetes
mellitus. If a patient's fasting blood glucose falls within this normal range,
he/she most likely does not have diabetes mellitus, whereas if the patient's
fasting blood sugar tests higher than the normal range, he/she probably has
diabetes mellitus and further tests can be performed to confirm the diagnosis.
Medications, such as insulin or oral diabetes medications can be prescribed to
lower abnormally high blood sugar levels.
Unfortunately, the normal range of LDL
cholesterol among "healthy" adults (adults with no known coronary heart disease)
in the United States may be too high. The atherosclerosis process may be quietly
progressing in many healthy adults with average LDL cholesterol blood levels,
putting them at risk of developing coronary heart diseases in the future.
What are desirable cholesterol blood levels?
Since no "normal" cholesterol levels
have been established, doctors rely on "desirable cholesterol levels" in making
treatment recommendations. However, the "desirable" levels of total cholesterol
and LDL cholesterol have been moving targets; they have been steadily declining
over the years as more and more controlled trials have demonstrated that the
risk of heart attacks and strokes can be reduced further with lower LDL
cholesterol levels.
In 1985, the National Heart, Lung, and Blood Institute
(NHLBI) of the National Institutes of Health gathered a panel of cholesterol
experts to form the National Cholesterol Education Program (NCEP). This expert
panel reviewed data mainly from large controlled cholesterol-lowering trials,
and published their blood cholesterol treatment recommendations in two separate
reports; one published in May, 2001, the other in June, 2004.
The NECP report
published in May 2001 is called the Adult Treatment Panel III (ATP III). This
report included desirable anvcd undesirable levels for LDL cholesterol, HDL
cholesterol, and triglycerides (see below), as well as LDL cholesterol lowering
target goals.
Since the publication of the ATP III report in 2001, several large
controlled trials have been published, showing that aggressively lowering LDL
cholesterol further reduced heart attacks and strokes. Therefore in June, 2004,
the expert panel lowered the LDL cholesterol targets, especially for patients
who have very high risks of developing heart attacks (see below).
Optimal, undesirable, and desirable lipid levels (published in 2001)
LDL cholesterol (mg/dl)
<100 Optimal
100-129 near or above optimal
130-159 Borderline high
160-189 High
> 190 Very high
Total cholesterol (mg/dl)
<200 Desirable
200-239 Borderline high
>240 High
HDL cholesterol (mg/dl)
<40 Low (undesirable)
>60 High (desirable)
Triglycerides (mg/dl)
<150 Normal
150-199 Borderline-high
200-499 High
>500 Very high
Next: What were the 2001 NCEP cholesterol treatment guidelines? »
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