Heart Disease - Prevention is better than cure

Dateline: 04/12/98

CHOLESTEROL GOALS

How can you reduce your risk of heart disease ? If you missed the other parts of this series, check them out now.

ACHIEVING TARGET CHOLESTEROL LEVELS

The recommended approach to blood cholesterol measurements is :

1. Measure total and HDL cholesterol levels

2. Assess positive and negative risk factors

3. Measure LDL cholesterol if

• total cholesterol is above 240 mg./dl
• total cholesterol is above 200 mg./dl, with two or more risk factors
• HDL cholesterol is below 35 mg./dl

4. Carry out tests to rule out secondary causes of high LDL (liver and thyroid function studies and uric acid estimation) and Start Step 2 diet (less than 30% fat, less than 7% saturated fat, less than 200 mg./day of cholesterol) and weight control if

• LDL is above 160 mg./dl
• LDL is above 130 mg./dl on 2 occasions, with two or more risk factors

5. Consider adding drug therapy to diet modification, if despite Step 2 diet therapy, LDL levels are

• above 160 mg./dl, plus two risk factors
• above 190 mg./dl
• above 220 mg/dl, in men over 35 years of age or premenopausal women

6. The AHA also has listed suggested drugs for treating LDL levels above 160 mg./dl, the priority of choice being modified according to triglyceride levels.

Triglycerides below 200 mg./dl

• Statin
• Resin
• Niacin

Triglycerides between 200 and 400 mg./dl

• Statin
• Niacin

Triglycerides above 400 mg./dl

• Combined drug therapy - niacin, fibrates, statin

If LDL goals cannot be achieved, combination drug therapy should be considered.

If HDL cholesterol is below 35 mg./dl, treatment involves

• emphasizing weight reduction
• encouraging physical activity
• stopping cigarette smoking
• niacin therapy, if patient has two or more risk factors and high LDL

Next : Physical Activity and Heart Disease