March 9, 2006

More people have cholesterol levels above optimum

By Elizabeth Crown

An estimated 63 million adults have low-density lipoprotein cholesterol (LDL-C) levels higher than what would be ideal as recommended by the National Institutes of Health.

Of that group, 38 million are people with health conditions that put them at increased risk for cardiovascular disease.

These findings, by Stephen D. Persell and co-researchers at the Feinberg School of Medicine, are reported in the February issue of the Journal of General Internal Medicine. Persell, who led the study, is assistant professor of medicine at the Feinberg School.

The study, which compared 2001 NIH cholesterol level targets with revised, more stringent, optimal targets issued in 2004, found that 10 million more adults had LDL-C (“bad cholesterol”) levels above the new targets.

The new guidelines recommend that physicians strive to get patients’ LDL-C levels lower, particularly for those at moderately high and high risk for heart disease.

“Nationally, we are far from achieving the 2001 goals, and as new evidence leads the NIH to push optional goals down further, the gap between what we believe to be ideal goals and what has been achieved gets even wider,” Persell said.

Too much LDL-C can build up on the inner lining of arteries that feed the brain and heart, and in conjunction with other substances form plaques that can clog vessels and cause a stroke or heart attack.

In combination with cardiovascular disease risk factors, such as high blood pressure, diabetes, tobacco smoking and/or family history of heart disease, high levels of LDL-C put individuals at increased risk for heart disease.

The goal for high-risk (heart disease or diabetes) patients is an LDL-C level was less than 100. However, a level of 70, rather than 100, is suggested in updated recommendations for those who are at very high risk for cardiovascular disease.

The new optional goal for those at moderately high risk is 100, compared to the 2001 goal of 130.

The study notes that despite the fact that nearly all persons in the high-risk group have LDL-C levels that are too high, 25 percent of them already use cholesterol-lowering medications, such as statins.

The study shows that many more people would need drug therapy to reach the recommended LDL-C levels, but it notes that a substantial number are unlikely to achieve these goals with standard-dose statins.

Current costs may also place those drugs out of reach for many. At current retail prices, a year’s supply of 40 milligrams daily of generic lovastatin can cost $450 to $700.

Costs per patient would be even higher if name-brand statins or high-dose statins and combination drug therapy are used.

The updated guidelines, published in July 2004, were based on a review of five major clinical studies of statin therapy conducted after the 2001 guidelines were released.

Persell’s co-investigators on this study were Donald M. Lloyd-Jones, M.D., assistant professor of preventive medicine and of medicine; and David W. Baker, M.D., associate professor of medicine and chief of general internal medicine.