Low Is Good - Lower May Be Better

Isn't it always this way? The minute you think you have control on something - the stock market, your relationship with your mother-in-low, the "in" hemline length - the rules change on you. And, we're sorry to report, it's happening again. This time, though, it's about your cholesterol. Fuelled by new research showing that reducing cholesterol to rock-bottom levels cuts heart attack risk, experts are preparing to revise the targets they consider healthy to numbers substantially lower than they are now.

The change - which would address total and LDL cholesterol (the bad stuff) but not HDL Cholesterol - may come in the next few years. How low will the numbers actually go? That's not clear yet. But an indication came in last year, when the US - based National Cholesterol Education Programme (NCEP), a government-coordinated coalition that sets the standards, lowered its LDL target by 30 points for people who are at high risk for heart disease. Christopher P. Cannon, M.D., an associate professor of medicine at Harvard Medical School, says a similar change would make sense for lower-risk people, too. Do the math for a healthy 40-year-old who has no risk factors, and that means he may soon be shooting for total cholesterol of 210 and LDL of 130 instead of the current 240 and 160. And as time goes on, I think the LDL levels considered healthy will continue to march lower and lower," Cannon says.

Recent research indicates that lowering LDL standards makes a lot of sense. In a landmark study published last year in The New England Journal of Medicine, Cannon and his colleagues found that heart disease patients who took a high dosage of a cholesterol-lowering stain drug saw their LDL levels plunge far below current standards; at the same time, the subjects' death risk over the next 2 years fell an extra 16 percent compared with risk for patients whose cholesterol merely met the standard after they took a lower dosage of another statin. In a separate trial reported in The Journal of the American Medical Association [1AMA), a high-dosage statin stopped patients' artery blockages from becoming larger. After reviewing five studies, the NCEP suggested last year that people at high risk for heart disease should consider shooting for LDL below 70 milligrams per decilitre (down 30 points from the previous standard). All these studies have also spurred some experts to wonder whether healthy people should consider making similar changes - possibly even using statins to achieve them.

That does make some sense, says Steven E. Nissen, M.D,, Medical Director of the Cardiovascular Coordinating Centre tit the Cleveland Clinic, because even if you're free of risk factors, there's no guarantee your heart is healthy. In fact, a number of people who die of a heart attack have no prior warning signs, Nissen says. And, he adds, even people with normal cholesterol who lower it by using statins can cut their death risk by nearly 30 percent. Why? It's not clear, but a recent review of previous studies found that arteries clog as long as LDL stays above 67 - or almost 100 points lower than the target for a healthy person.

Nissen, co-author of the JAMA study, also points to research showing that people in rural parts of Africa, South America, and Australia, who live much the same way their ancestors did thousands of years ago, have LDL in the range of 50 to 75 and no evidence of heart disease. "We're evolutionarily adapted to have much lower cholesterol than what we today consider to be healthy," he says.

Still, if new cholesterol guidelines are developed for healthy people, don't expect them to trumpet the use of statins. Yes some researchers estimate heart disease could be cut by 80 percent if only we'd all pop a daily pill containing a statin and five other agents (including aspirin and folic acid), and studies show that statins may also prevent some cancers, Alzheimer's disease, osteoporosis, and arthritis. But the NCEP and the American Heart Association (AHA) aren't about to endorse these drugs for people who don't really need them. Roughly 5 percent of users experience muscle or liver impairment, according to some experts, which means that millions of people could get sick if everyone took statins. For high-risk patients, the benefits are unquestionably worth the dangers, says James Cleemon, M-D., coordinator of the NCEP, but this kind of therapy isn't for everyone.

What is for everyone? A heart-healthy lifestyle. The following guide-lines should be noted:

Manage your cholesterol by maintaining a healthy weight
Exercise at least 45 minutes per day most days of the week.

Limit saturated fat to 10 per cent or less of your caloric intake while avoiding foods loaded with trans fat, such as cookies and chips and keep your dietary cholesterol intake below 300 milligrams per day (or less than. 200 milligrams if you're at high risk).

Follow this plan, and odds are you won't have to worry about your cholesterol if your risk of heart disease is low. Your numbers should be just fine.

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