NCEP, the National Cholesterol Education Program, was created by the National Heart Lung and Blood Institute (NHLBI) based on scientific studies about the relationship between cholesterol levels and heart disease. Steps to reduce risk include knowing what cholesterol levels mean, monitoring individual levels and taking action--such as diet and lifestyle changes and/or prescription medications--to change levels that are not in line with heart-healthy outcomes.
Identification
Cholesterol is carried around the body in cells of mixed fat and protein called lipoproteins. Low-density lipoproteins (LDL) have more fat and cholesterol and are referred to as "bad cholesterol." These packages deposit artery-clogging plaque in the vessels, which can lead to heart attack and stroke. The high-density lipoproteins (HDL) are the "good cholesterol" packages. They contain more protein and carry damaging deposits away from the arteries back to the liver for recycling.
Guidelines for Cholesterol Levels
The latest cholesterol guidelines are based on the third study of the Adult Treatment Panel (ATP III) in 2001. The optimal total cholesterol level is less than 200 mg/dL; a range from 200 to 239 mg/dL is borderline high. Desirable LDL cholesterol range is below 100 mg/dL; from 100 to 129 is near optimal. An HDL level lower than 40 mg/dL is undesirably low; 60 mg/dL is considered high. Remember, higher HDL levels are good.
Risk Factors
The NCEP recognizes that certain risk factors predispose a person to heart disease. With risk factors present, the cholesterol guidelines are more stringent. A person who has heart disease is more likely to have a recurring episode of stroke or heart attack. This patient would be treated more aggressively and started on some type of therapy for an LDL level greater than 100 mg/dL. A healthy person with the same level simply would continue to monitor the numbers. Other risk factors include hypertension, a family history of heart disease, cigarette smoking and age 45 or greater for males and 55 or greater for females. If two or more of these risk factors are present, a treatment plan for high cholesterol would be started at a lower LDL level than if no risk factors are present.
Lifestyle Changes
Lifestyle changes are the first line of intervention for undesirable cholesterol levels. These are safe modifications lacking side effects that medications can bring. Examples are dieting to lose weight; other diet modifications, such as lowering intake of dietary cholesterol, fat and saturated fats and increasing dietary fiber; smoking cessation; and increasing physical activity. Most of these changes can decrease bad cholesterol levels as well as increase HDL cholesterol.
Drug Therapy
Drug therapy generally is not considered for individuals with fewer than two risk factors until LDL levels are at least 160 mg/dL. However, medications are recommended for those at a significantly greater risk with LDL levels as low as 100 to 130 mg/dL. At this level, the benefits of the medications are believed to outweigh any concurrent risk.
