Lower Cholesterol Targets Urged

NIH Panel Endorses More Aggressive Strategy

Millions of Americans should consider trying to drive their cholesterol levels lower than had been previously recommended, the government said yesterday, endorsing a more aggressive strategy for fighting heart disease, the nation's leading killer.

People at high risk for heart attack or stroke should explore with their doctor the option of taking higher doses of cholesterol-lowering drugs to cut their level of "bad" cholesterol below current targets, according to the National Cholesterol Education Program of the National Institutes of Health, which sets federal standards for preventing cardiovascular disease.

"The lower, the better, for high-risk people," said Scott M. Grundy of the University of Texas Southwestern Medical Center at Dallas, who chaired the panel that produced the guidelines. "That's the message."

By focusing attention on the benefits of reaching ultra-low cholesterol levels, the new guidelines are expected to intensify treatment of patients at the greatest risk and also push millions of others to begin treatment to lower their cholesterol, experts said.

"It's an important step forward," said Christie M. Ballantyne, a cardiologist at Baylor College of Medicine in Houston. "This affects millions of Americans and if implemented should lead to marked benefits by reducing heart attacks and strokes."

The move could mark the start of an eventual lowering of target cholesterol levels for all groups if research shows similar benefits for people at lower risk, experts said.

Evidence has been mounting that the lower cholesterol levels drop, the greater the benefit, and some doctors have begun treating cholesterol more aggressively. But this is the first time the government has validated the approach.

Heart disease is by far the nation's No. 1 cause of death, killing about 1.5 million Americans every year. High cholesterol increases the risk for heart attacks and strokes by accumulating inside arteries, narrowing passageways supplying blood to the heart and brain, and increasing the risk of a blood clot.

Because of growing evidence that lower cholesterol levels are healthier, the National Cholesterol Education Program convened the nine-member panel to review five major studies published since the last guidelines were issued in 2001.

In a paper published in today's issue of the journal Circulation, the panel created a new category of patients who should be considered at very high risk and recommended they consider lowering their levels of bad, or LDL (low-density lipoprotein), cholesterol to below 70. Previous guidelines said they should cut LDL to 100 or less.