Washington To cut their risk of heart disease, nearly three times as many Americans should be taking cholesterol-lowering drugs, and they and millions more ought to be eating fewer burgers and other fats, exercising more and losing weight, the government says.
"This is something we cannot be complacent about," Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute, said Tuesday in announcing the new recommendations.
Heart disease risk is much higher than has been recognized, added Dr. James I. Cleeman, director of the National Cholesterol Education Program. Already, heart disease kills 500,000 Americans annually.
The new guidelines call for early testing for cholesterol, recommend a diet with low levels of saturated fats and increased fiber, and urge people to strive for at least 30 minutes of exercise daily.
Dr. Scott M. Grundy of the University of Texas Southwestern Medical Center at Dallas said that if the new guidelines are followed, they have the potential to reduce heart disease by 30 percent to 40 percent.
"In terms of cost-effectiveness, diet is clearly the winner, if people will follow the diet," Grundy said.
An estimated 53 million Americans have high cholesterol and millions more are borderline.
Diet and exercise can benefit 65 million adults in both high and low heart-disease risk categories, the physicians stressed.
The new recommendations urge at least some form of mild exercise brisk walking, bicycling, swimming and even include a selection of suggested recipes on the Institute's internet site: www.nhlbi.nih.gov.
For people at high risk, the guidelines call for more aggressive medical treatment, adding drugs to the lifestyle changes. The guidelines increase the number of people thought to need cholesterol-lowering drugs from about 13 million Americans to 36 million.
The recommendations update guidelines issued eight years ago.
They set the same level of 200 milligrams or less of total cholesterol per deciliter of blood as advisable and 240 mg as too high.
While people under 240 mg are not usually given treatment now, the guidelines urge lifestyle changes for those between 200 mg and 240 mg.
The new guidelines add more detail, setting 100 mg as the optimal level of low-density lipoprotein, the so called "bad" cholesterol that can accumulate in the arteries, eventually causing heart attack or stroke. For LDL, a reading of 100 to 129 is above optimal, 130 to 159 is borderline high, 160 to 189 is high and 190 and above is very high.
For HDL, known as "good" cholesterol, the guidelines set a reading of 40 mg as too low, up from the 35 mg previously considered too low. HDL can reduce the risk of heart disease.
The guidelines also call on doctors to give more detailed blood tests to check cholesterol levels and urge them to consider multiple risk factors for heart disease in deciding on treatment.