New NIH cholesterol guidelines - Special Report - National Institutes of Health

American Fitness, Jan-Feb, 2002 by Shirley J. Archer

Lifestyle factors play an important role in reaching and maintaining healthy cholesterol levels, according to the May 2001 cholesterol guidelines issued by the National Cholesterol Education Program (NCEP) within the National Institutes of Health (NIH). These guidelines, based heavily on the latest scientific evidence on cholesterol testing and treatment, are the first new guidelines since 1993. "These guidelines call for more aggressive treatment of people at risk for heart disease," affirms James Cleeman, MD, coordinator of NCEP.

The guidelines recommend adults, age 20 and older, have cholesterol levels screened with a complete fasting lipid profile, including total cholesterol, LDL ("bad") cholesterol, HDL ("good") cholesterol and triglycerides (fatty substances in the blood) every rive years. For individuals with elevated cholesterol levels, the guidelines recommend "Therapeutic Lifestyle Changes (TLC)" and medication when indicated.

Approximately 101 million Americans may have elevated cholesterol levels. Consequently, as many as 65 million should be making lifestyle changes. The indicated changes include improving eating habits, managing weight and increasing physical activity. "This report is not about making the fit even more fit, [but] about people who are sedentary and need to move into active living. If fitness professionals can support these people in making physical activity a part of their lifestyle, it can be an important contribution to health," says Neil Stone, MD, a member of the NCEP Expert Panel and professor of clinical medicine (cardiology) at Northwestern University Medical School.

Lifestyle Factor and the Metabolic Syndrome

The NIH cholesterol guidelines place primary emphasis on preventing heart disease through Therapeutic Lifestyle Changes--a lifestyle approach to reducing the risk of coronary heart disease. "There are millions of Americans at high risk who need to lower their levels of LDL cholesterol. They [can achieve this] through Therapeutic Lifestyle Changes, which include a diet low in saturated fat and cholesterol, high in fiber and plant stanols and sterols," explains Cleeman. "Weight management and physical activity are equally important components of lifestyle changes. Clearly, fitness professionals have an opportunity to help people lower LDL cholesterol levels and [prevent] high cholesterol."

The TLC guidelines recommend people with high cholesterol improve their eating habits. Therefore, their total dietary fat should be composed mostly of unsaturated vegetable fats and range from 25 to 35 percent of total calories. This recommendation is based on scientific evidence that indicates a higher intake of unsaturated fat reduces triglycerides and raises HDL cholesterol in people with "metabolic syndrome."

Another new feature of the guidelines is an emphasis on treating people with metabolic syndrome, which is closely linked to insulin resistance. Metabolic syndrome is characterized by a cluster of heart disease risk factors aggravated by being overweight. "The centerpiece of the metabolic syndrome is atherogenic dyslipidemia, the simplest form of which is elevated triglycerides (>150 mg/dL) and low HDL-C (<40mg/dL), however, there is much more to the lipid and lipoprotein story than that," explains Ralph LaForge, managing director of the Duke Lipid Clinic and Disease Management Preceptorship Program at the Duke University Medical Center in Durham, North Carolina.

According to LaForge, the new NIH guidelines present a market opportunity for fitness professionals because sufficient weekly exercise can reduce up to 90 percent of the risk. "Early therapy should include both dietary measures, but perhaps more importantly, 1500 kcal or more exercise per week with the primary focus on reducing abdominal visceral fat stores, as measured by waist circumference," says LaForge. Exercise and dietary therapy precedes prescription of medication by physicians. If these measures are successful in improving cholesterol levels as well as managing weight, not only will risks of taking prescription medications be avoided, but patient's health care costs will drop considerably. By some estimates, says LaForge, medications alone can easily cost more than $2,000 annually.

Cholesterol Testing in Health & Fitness Centers

Cholesterol levels are very responsive to increased levels of physical activity. This can be a great motivating factor for people who become frustrated with an exercise program because they do not believe they are achieving any results. At the Health and Fitness Institute in Lindenhurst, Illinois, cholesterol testing is offered during a new member's fitness assessment. According to Amber Webster, General Manager, re-testing is performed at members' request.

At the Health and Fitness Institute, cholesterol testing is offered through the Cholestech L-D-X[R] System, a CLIA-waived cholesterol testing system that can provide results of a full lipid profile from a finger stick of blood in rive minutes According to Webster, "This information is very useful in a members decision to make a lifestyle change. They've already made a partial commitment by purchasing a membership, [and] the value of this purchase is reinforced when they receive information regarding the status of their current health."

How Fitness Professionals Can Help

Fitness professionals can help improve health and reduce the risk of heart disease--the number one cause of death for Americans. "If fitness professionals [are] familiar with the guidelines and help people achieve their goals of increasing physical activity and effectively managing weight, I think they can position themselves as partners with health care providers and patients in this process," says Cleeman.