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There is bad news and good news on the cholesterol front. In a wide range of studies, scientists are linking high blood levels of the compound to a growing number of dangerous disorders. However, cholesterol-reducing treatments are proving to be even more beneficial than anyone dared hope.

It was just a year ago, in fact, that doctors at the National Heart, Lung, and Blood Institute reviewed medical experience with statins, the drugs most commonly used to lower cholesterol levels. The experts were so impressed that they hurriedly changed their guidelines for treating cholesterol.

The new rules are a lot more aggressive than the old ones were. They call for treatment at levels of LDL, the dangerous form of cholesterol, more than 130. This threshold is significantly lower than the old guidelines called for, raising the number of Americans requiring treatment to 36 million, up from 13 million last year.

The latest research strongly supports that change. In the largest study of its kind, scientists at Oxford University reviewed more than 20,000 men and women at high risk for a heart attack or stroke; yet their cholesterol levels were only a little above normal.

The results were dramatic. Over five years, drug treatment cut the risk of heart attack or stroke nearly 30 percent. Risk of death fell by nearly 20 percent. Even those with the lowest cholesterol levels benefited. "This is a stunning result with massive public-health implications," declared Oxford cardiologist Rory Collins, who headed the study.

And heart disease is not the only disorder linked to cholesterol. Women face a 23 percent higher risk of dying of a clot-related stroke if they have high cholesterol levels, according to Dr. Lori Mosca, at the Columbia University College of Physicians & Surgeons, in New York. It's worse for African-American women. Their risk is 76 percent higher when young and 48 percent higher later in life. Even more alarmingly, high cholesterol also raises our risk of developing Alzheimer's disease. In one study, scientists at the University of Kuopio, Finland, found that high cholesterol levels doubled their patients' chances of losing their memories to this illness. For those who also had high blood pressure, the risk was 3.5 times higher. Most recently, scientists at the University of Tübingen, Germany, found that the cholesterol-lowering medication simvastatin reduced levels of a material called apolipoprotein-beta 40 (Abeta 40) in patients with mild Alzheimer's. Abeta 40 is one of several proteins that appear to destroy crucial nerves in the brains of Alzheimer's patients.

While cholesterol-lowering drugs are lifesaving for many, more radical approaches are coming online as well. Just two years ago, a teenager at Cedars-Sinai Medical Center, in Los Angeles, Calif., became the first person to undergo LDL apheresis. In this process, blood is removed from a patient's vein and sent through a machine rather like an artificial kidney. The machine removes the "bad cholesterol" from the blood and returns the rest to the patient. It is a costly two-hour process that must be repeated every few weeks, but for patients who do not respond to less heroic treatments, it can be a lifesaver.

At the Howard Hughes Medical Institute, in Chevy Chase, Md., meanwhile, Dr. David Mangelsdorf and his colleagues are developing a therapy to block the uptake of cholesterol into the cells, where it can begin to do damage. Eventually, Dr. Mangelsdorf speculates, "by carefully monitoring drug dosages and cholesterol levels, you could essentially 'dial in' exactly the level you wanted a person's cholesterol to be."

Even farther out, scientists at Gencell, a biotech company in Vitry/Seine, France, have developed a gene therapy that all but eliminates the cholesterol plaques that cause heart disease. In mice, at least, the treatment did not just stop plaque formation but actually cleared the existing deposits. Treated mice also had a sharp increase in the "good" HDL cholesterol and a drop in LDL. Their total cholesterol levels sank from an appalling 591- the high end of normal in humans is only 200 - to just 92 in only three weeks. For most human patients, this could virtually eliminate the risk of heart attack.

Both these treatments, uptake blockers and gene therapy, are years from human use. Yet it is beginning to seem that by the time the baby boomers start to reach their 60s in the coming decade, cholesterol problems could be a thing of the past.

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