Emory Report

June 12, 2000

 Volume 52, No. 35

Cholesterol problems may affect as many as 28 million

By Lillian Kim

Researchers at Emory and the Baylor College of Medicine have concluded that many more Americans than previously thought-perhaps as many as 28 million-may need cholesterol-lowering drug therapy to reduce their risk of heart disease. The study appeared recently in The Archives of Internal Medicine.

Cholesterol levels just under 200 are commonly considered in the upper limit of the healthy range. Yet many people whose cholesterol levels fall in this range still are at high risk of heart disease due to other factors such as smoking, diabetes, family history, high blood pressure and low levels of HDL or "good" cholesterol.

"What we found was that the numbers [of people at risk] are much higher than anyone ever thought," said Terry Jacobson, lead author and associate professor of medicine.

The study, which analyzed data from 6,796 adults 20 years and older who participated in the most recent National Health and Nutrition Examination Survey (NHANES III), was based on the guidelines established by the National Cholesterol Education Program Adult Treatment Panel II. According to the guidelines, people without heart disease should be treated for high cholesterol if their "bad" (LDL) cholesterol level exceeds 160 milligrams per decaliter blood. About 10.4 million Americans fit this definition.

But the guidelines also recommend that doctors exercise "clinical judgment" to determine whether to treat patients whose LDL cholesterol falls under the 160 mg/dL threshold-yet have other cardiovascular risk factors. For instance, people with LDL cholesterol levels between 130 and 159 but who smoke and have high blood pressure also may need treatment.

The recommendations increase the estimated number of people who might require drug therapy to 28.4 million-nearly three times the previous estimate. Recent clinical trial evidence indicates that drug treatment of patients with borderline LDL cholesterol levels and other cardiac risk factors will reduce their risk of heart attack.

"What we define today as 'average' or 'normal' cholesterol probably is too high, because Americans have too many other risk factors," Jacobson said, citing the increased prevalence of obesity and sedentary lifestyle as examples.

Although studies have shown that treatment reduces the risk of coronary heart disease in those with "average" cholesterol levels, the enormous cost of treating additional millions is a daunting consideration, noted Jacobson, who directs the Office of Health Promotion and Disease Prevention at Grady Hospital.

"With so many people at risk of heart disease in this country, how are we going to get both nonpharmacologic and pharmacologic therapy to them without breaking the bank?" Jacobson said.

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