Cholesterol counts: what do they add up to? - National Cholesterol Education Program nutritional guidelines

Nation's Business, April, 1988 by Phyllis M. Barrier

Cholesterol Counts: What Do They Add Up To?

Cholesterol. That word has entered the public's awareness in recent years. High levels of cholesterol in the blood promote atherosclerosis-hardening of the arteries-and it is our major killer, causing more deaths than all forms of cancer combined.

But once past a general awareness that cholesterol is important, most people entered a mysterious realm of "cholesterol counts" and dietary guidelines that seemed to shift constantly. For the person who simply wanted to reduce the risk of heart attack or stroke, it all could be a little daunting.

Last October, the expert panel of the National Cholesterol Education Program, an arm of the National Heart, Lung and Blood Institute, issued new guidelines that promise to bring a welcome new uniformity to a hitherto confusing area. The new guidelines make it easier to decide if you have a problem-and to know what to do about your problem if you have one.

The NCEP panel recommends that cholesterol levels be measured every five years in adults over the age of 20. The panel classifies a cholesterol level below 200 milligrams per deciliter (a deciliter is about one tenth of a quart) as "desirable blood cholesterol," between 200 and239 mg/dl as "borderline-high blood cholesterol," and 240 mg/dl and above as "high blood cholesterol."

For the first time, the guidelines take into account other risk factors for heart disease in determining if a given cholesterol level is acceptable. Hypertension, cigarette smoking, diabetes mellitus, severe obesity (more than 30 percent above ideal body weight), a family history of premature heart attack (before the age of 55), a personal history of heart disease or stroke, even being a member of the male sex-all of these factors help determine whether a given cholesterol level is really acceptable.

If, for example, your cholesterol count is between 200 and 239 mg /dl-in the borderline range-the NCEP recommends that a second count be made and averaged with the first. If this averaged cholesterol count is also between 200 and 239, and you do not have heart disease or at least two other risk factors, you should follow a prudent diet and be rechecked in a year.

For a full 25 percent of the American population-those people with cholesterol counts of 240 and above--another test should be done to analyze the levels of the different forms in which cholesterol is carried in the blood. Low-density lipoprotein cholesterol (LDL) is considered the most dangerous.

If you have no heart disease and only one other risk factor, your LDL count can be as high as 160 mg/dl before any warning flags go up. If you have heart disease or two or more other risk factors, your LDL count should be no higher than 130.

The NCEP's dietary guidelines are the same if either total cholesterol or LDL cholesterol is too high. In fact, its recommendations should be followed by those people who want to hold their cholesterol to an acceptable level, as well as by those who want to reduce it.

There is not space here to discuss the NCEP's recommendations in detail, but cutting back on fats and oils of all kinds-and saturated fats in particular-is probably the best way to reduce blood-cholesterol levels.

Saturated fats, found in dairy products, meat fats, and palm and coconut oils, are hard at room temperature. Fats of all kinds should be reduced to less than 30 percent of calories (they make up 40 percent of the typical American's diet). You can do that by eating fish, lean red meat, poultry without the skin and low-fat (I percent or skim) dairy products.

Even with the most stringent diet changes, some people will not be able to lower their LDL cholesterol sufficiently, and they will have to consider drug therapy.

Taking drugs from the start may, in fact, seem like the easy way out. But the easy way out really isn't very easy: The medication must be combined with a very stringent diet, it is expensive and it has side effects.