
The United States sponsored National Cholesterol Education Program (NCEP) first issued updated guidelines in 2001 for detection, evaluation, and treatment of high blood cholesterol levels. In 2005, an expert panel issued revised guidelines – based on evidence from several new clinical trials – that call for even more aggressive lipid lowering therapy for people at high risk of a heart attack. The Key Recommendations Were As Follows: *Everyone age 20 or older should obtain a lipid profile (sometimes called a lipoprotein profile) after a 12 hour fast. This test measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. *If you are healthy, your results are all in the desirable range (total cholesterol of 200 mg/dl; LDL cholesterol 100 -129 mg/dl; HDL cholesterol of 60 mg/dl; triglycerides 150 mg/dl), and you have no other risk factors for coronary artery disease – which includes older age, smoking, hypertension, diabetes, HDL cholesterol below 40 mg/dl, and/or a history of premature CHD in a first degree relative (parent, sibling, or child) – then you should be retested in five years. *The target for people with one coronary artery disease risk factor is an LDL level of less than 160 mg/dl. In most individuals who do not have diabetes or know vascular disease, but have two or more risk factors, LDL levels should be kept below 130 mg/dl. *In patients with any form of know cardiovascular disease (who are at high risk of heart attack), the NCEP guidelines recommend that LDL cholesterol be lowered to less than 100 mg/dl. This target also applies to individuals with diabetes, which is now designated as a “Coronary Artery Disease equivalent” rather than simply another risk factor for CHD. The newest guidelines suggest an LDL target level of less than 70 mg/dl for these high risk individuals – and recommend that patients consider drug therapy even if LDL cholesterol levels are below 100 mg/dl. *A high level of HDL cholesterol (60 mg/dl or high) is considered protective against coronary artery disease. A high HDL level cancels out the effects of one other CHD risk factor when determining the total number of risk factors. *The NCEP guidelines emphasize the dangers of metabolic syndrome, which is largely related to obesity and inactivity. High blood pressure, low HDL cholesterol, high triglycerides, high blood sugar, and abdominal obesity are among the diagnostic features. *Based on your test results and an assessment of your risk factors, your doctor will decide on treatment, usually beginning with lifestyle changes. When lifestyle modification fails to lower LDL levels adequately, your doctor may suggest a cholesterol lowering medication or alternative natural remedies depending on his/her field of expertise.
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