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Back To Vidyya September Is National Cholesterol Education Month

Get Ready For Cholesterol Month 2000

"Keep the beat—Cholesterol counts for everyone" is the theme for Cholesterol Month 2000. This theme reinforces the idea that cholesterol lowering is important for all Americans, regardless of age, sex, and whether or not coronary heart disease (CHD) has been diagnosed. Those who have CHD and those who would like to prevent it both benefit significantly from cholesterol lowering.

The message that cholesterol lowering is important for everyone is being incorporated into the National Cholesterol Education Program's (NCEP) activities. A significant activity that is under way is updating the cholesterol clinical guidelines. Since last September, the NCEP has convened an expert panel (Adult Treatment Panel III [ATP III]) to update the existing adult treatment guidelines. Some of the areas being addressed in the new guidelines include: the implications of recent clinical trials; the LDL-cholesterol target in CHD patients; integrating the treatment of high triglycerides with cholesterol management; whether HDL-cholesterol should be a target of therapy; primary prevention; CHD risk assessment; dietary therapy and life habit interventions; drug treatment; adherence and compliance issues; cholesterol management in diabetes; and special considerations for population groups such as older adults, women, young adults, middle-aged men, and racial/ethnic groups.

The ATP III report is due to be released in the spring of 2001. Release of the new guidelines will be followed by a joint national conference co-sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and the National Committee for Quality Assurance (NCQA). The goal of this conference is to speed the adoption and implementation of the guidelines by practitioners and health care organizations. This innovative conference will offer practitioners the first in-depth look at the ATP III guidelines, as well as expert advice and tools to help implement the guidelines in actual practice. Existing NCEP patient education materials will be updated to reflect the recommendations made in ATP III, and Web-based applications of the new guidelines will be developed. NCEP is considering several possibilities, including a Web-based continuing medical education module for the "Live Healthier, Live Longer" Web site, Palm Pilot applications, and a 10-year CHD risk calculator.

This year's Cholesterol Month community kit features a variety of materials and tools to address 2 important areas of focus: 1) cholesterol lowering in primary prevention and in those with CHD, and 2) cholesterol lowering in men and women of all ages. In addition to the community kit, related cholesterol month activities include new tips for cholesterol lowering on the "Live Healthier, Live Longer" Web site (, a Web-based version of the community kit, and a matte feature article to emphasize the importance of cholesterol lowering for all adults. A complimentary hard copy community kit can be ordered through the National Heart, Lung, and Blood Institute Information Center by calling 301-592-8573. To access the Web-based version of the community kit, go to and look under "Highlights."

Cholesterol Counts for Everyone

For men and women

Clinical trials addressing cholesterol lowering and CHD in middle-aged men with and without CHD have shown that men benefit greatly from cholesterol lowering. Recent clinical trials have shown that women benefit from cholesterol lowering as much as men. Because the lifetime risk of developing CHD is high for both men and women even before the age of 40, it is important to begin cholesterol lowering as early as possible. One out of every 2 men aged 40 and younger, and 1 out of every 3 women aged 40 and younger, will develop CHD sometime in their life.

For Young Adults

It has been shown that atherosclerosis begins during the teen years and early 20s. High cholesterol levels in young adulthood significantly increase the risk for developing CHD later in life. The Framingham Heart Study showed that young adults with lower cholesterol levels have greater longevity and lower cardiovascular mortality. This has recently been confirmed in a very large pooled study. [Citation: Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA. 2000;284:311-318]. Establishing a healthy eating pattern and other positive habits early in life is an important step in keeping CHD risk low. It is important to measure cholesterol levels in young adults so that life habit changes that decrease the lifetime risk for CHD can be initiated early. Waiting until mid-life to measure and treat cholesterol can be costly. Approximately one-third of first CHD events are fatal, leaving no second chance. Once CHD has become manifest, there is usually a lot of atherosclerosis to treat. Although cholesterol lowering in those with CHD has been shown to be highly beneficial, once CHD is present it is not possible to eliminate all of the excess risk.

For Older Adults

Among older Americans, cholesterol lowering is beneficial for those with CHD as well as those trying to prevent it. As a group, older Americans (over 65 years) have the highest rate of CHD. Up to three-quarters of older individuals have either obvious or subclinical disease. Even among men who reach 70 years of age without obvious CHD, 1 out of every 3 will still develop the disease in his remaining years; among women free of CHD at age 70, 1 out of every 4 will go on to have the disease. Furthermore, clinical trials in people with CHD and in primary prevention demonstrated that older participants reduce their CHD risk with cholesterol lowering as much as middle-aged ones. Of particular interest is that cholesterol lowering also reduced the occurrence of strokes in older persons. In older adults, life habit changes are the foundation of treatment for primary prevention, and a combination of life habit changes and drug therapy will often be needed in those with CHD.

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Editor: Susan K. Boyer, RN
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