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Panel Urges Testing of 'Good Cholesterol'

March 17, 1992|KATHLEEN DOHENY

Just when you thought you knew everything about cholesterol testing, along comes more advice:

It's not enough to measure total cholesterol levels anymore. What you need to know is the status of your high-density lipoproteins (HDLs)--the so-called good cholesterol, according to new recommendations.

The suggestion to expand routine testing was issued last month by a 12-member panel of independent experts convened by the National Institutes of Health.

The recommendation, under consideration by officials at the National Cholesterol Education Program, followed a review of numerous worldwide studies of heart disease.

Not everyone agrees with the recommendation.

Some doctors say people at minimal risk for heart disease need nothing more than a measurement of total blood cholesterol, not more extensive evaluation of HDLs and low-density lipoproteins or LDLs, the so-called bad cholesterol.

Of the recommendations, Irving Paul Ackerman of Kaiser Permanente, Los Angeles, says, "I think that's fine for a person with multiple risk factors. But for low-risk, healthy people, it is a waste of money."

According to the panel, 5% to 10% of people given a clean bill of health because their levels fall below the "desirable" level--200 milligrams per deciliter of blood--might actually have unhealthily low levels of good cholesterol. (HDL molecules are believed to prevent or reverse fatty buildups in the arteries.)

More attention should also be paid, the panel recommends, to levels of triglycerides, those fatty substances in the bloodstream believed to contribute to heart disease risk.

In a study reported recently in the journal Circulation, analysis of the five-year Helsinki Heart Study, involving more than 4,000 middle-aged men, concludes that elevated triglyceride levels contribute to heart disease risk.

The recommendations to pay more attention to HDL and triglycerides don't minimize the importance of evaluating LDLs, says Elliot Rapaport, UC San Francisco professor of medicine who chaired the panel.

"LDLs are still an important determinant of risk," he says.

Locally, physicians say they have routinely ordered measurements of good, bad and total cholesterol when evaluating a patient with known risk factors for heart disease, such as cigarette smoking, high blood pressure, obesity or diabetes.

On one point most doctors concur: No treatment decisions should be based on a single cholesterol test measurement.

If measurements are abnormal, they should be retaken, the panel says, at least twice, ideally three times, to rule out errors. Weekly intervals between measurements are suggested.

In general, total cholesterol levels below 200 milligrams per deciliter of blood are considered "desirable."

LDL levels of 130 milligrams and above indicate an increased risk of heart disease, according to the American Heart Assn. HDL levels below 35 milligrams per deciliter of blood also indicate increased risk, the panel says.

In general, adults should get an initial cholesterol test at age 20, with follow-up tests scheduled on the basis of results and an individual's risk factors for heart disease. The test takes only a few minutes and involves drawing a small amount of blood for analysis.

If your cholesterol test results yield bad news--even after repeat measurements--the NIH panel first recommends lifestyle changes, such as:

* Smoking cessation.

* Weight loss if needed.

* Exercise.

If your total cholesterol still isn't lowered, medication might be prescribed. Raising the levels of good cholesterol helps reduce heart disease risk.

"For every one milligram increase in HDL, there is a 2% to 3% decrease in heart disease risk," says Richard J. Gray, director of surgical cardiology at Cedars-Sinai Medical Center, citing several studies.

Stopping cigarette smoking is one of the best ways to raise HDLs, he says. Weight loss also tends to increase good cholesterol, he adds, as does regular exercise.

To help understand cholesterol and decrease intake of cholesterol-rich foods, there are a variety of brochures available.

The American Heart Assn. publishes "Cholesterol and Your Heart" (English and Spanish versions; special version for those age 55 and above) and "The AHA Diet--An Eating Plan for Healthy Americans."

Request brochures by title by calling (800)-HEART-LA (in Los Angeles County) or by writing the AHA Greater Los Angeles affiliate, Box A, 3550 Wilshire Blvd., fifth floor, Los Angeles, Calif. 90010.

The National Cholesterol Education Program publishes a brochure on cholesterol and another on low-cholesterol eating.

Write: National Cholesterol Education Program, 7200 Wisconsin Ave., Artery Plaza, fifth floor, Bethesda, Md. 20814-14820.

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