1. The definition of a dangerously low high-density lipoprotein cholesterol (HDL-good cholesterol) has changed. HDL, in essence, carries cholesterol away from the heart to be metabolized and excreted. A normal HDL is 40 milligrams and above - and with HDL, the higher the better. Women tend to have higher HDL levels and that helps protect them from heart attacks. Previously, this expert group, for a somewhat inexplicable reason, had set 35 and below as a risk factor for coronary heart disease and heart attacks. Now that danger level is set at any value below 40 where it always should have been. Healthful Life has always considered 40 as the cut off between acceptable and potentially dangerously low HDL levels. If your HDL is too low, raising it may be difficult; weight loss, a glass or two of wine a day, and, if you are a smoker, stopping may help.

2. They continue to urge screening of young adults (men ages 20 to 35, women 20 to 45 years), noting "long-term prospective studies reveal that elevated blood cholesterol detected in young adults predicts a higher rate of premature coronary heart disease in middle age. Thus, risk factor identification in young adults is an important aim for long-term prevention". That is important because some expert groups do not advocate screening of younger adults claiming they are afraid too many people will end up on cholesterol-lowering drugs. The recommendation here is for blood tests every five years. Healthful Life does a cholesterol and HDL every other year at the biennial prevention examination. Not to screen for cholesterol and HDL in younger adults makes no sense to us. How can people be expected to take charge of their own medical destinies if the medical profession were to try and deny them information on their own potential risk factors?

Furthermore, the evidence shows that earlier intervention is more effective; for example, lowering a high cholesterol by 10 percent at age 35 is estimated to cut heart attack risk related to cholesterol levels by more than 50 percent. If you delay until age 50, you can expect a 40 percent reduction in heart attack risk. Delay until age 60 to reduce the cholesterol, and you can prevent 27 percent of heart attacks; wait until age 70, and that figure drops to 20 percent. So, early detection of a high cholesterol or low HDL is a good idea.

3. This report accentuates drug treatment for high cholesterol or high LDL. Currently, 13 million people take cholesterol-lowering drugs. If this report is followed too zealously, an estimated 36 million people (about one in six adults) in the United States would be on these powerful drugs. That is a huge number. The drugs seem reasonably safe, but there are some short-term adverse side effects that occasionally can be severe and we do not yet know enough about possible long-term effects. The best approach is early detection and non-drug therapy, including diet (see Archives "So you want to lower your cholesterol level without taking drugs"), weight loss, and exercise. Cholesterol levels increase with age. The longer you wait to lower an increasing cholesterol level, the greater the risk to your heart and the more likely your cholesterol (or LDL) level will be high enough that diet, exercise, and weight loss will not be effective and you will require cholesterol-lowering drugs. So, regular screening and detection of a high or rising cholesterol starting at age 20 makes very good sense.

4. There is not enough emphasis on duration of high cholesterol or low HDL. The longer you have an unmodified high cholesterol, the greater the risk of coronary heart disease. There also is no mention of cholesterol to HDL ratios. That is very useful (4 or less is excellent, 5 is borderline high, and 6 or more indicates a definitely increased risk of heart attack). The expert panel also wants to measure LDL and pay more attention to triglycerides, but it is still not clear whether that adds significantly to knowing your cholesterol, HDL, and cholesterol:HDL ratio.

5. As a result of this report, there will be a lot of people who will use a table or website to calculate their own ten-year risk of heart attack. But, that can be misleading. Healthful Life believes it is easier to just measure regularly and do something about the major risk factors (cholesterol (or LDL), HDL, blood pressure, weight, and, of course, smoking).