Doctors: LDL levels are doable

Cardiologists knew the LDL benchmarks were being lowered.
By WILLIAM K. ALCORN
VINDICATOR HEALTH WRITER
YOUNGSTOWN -- Area cardiologists say the new lower guidelines for cholesterol levels, created by the National Cholesterol Education Program, are both doable and life-saving.
NCEP's lower benchmarks for LDL, the so-called "bad" cholesterol, are:
UFor very high-risk heart patients, such as those who have had a previous heart event, 70, down from 100.
UFor high-risk people who have not had a heart event but have multiple risk factors, under 100.
UFor moderately high-risk, those who have multiple risk factors such as diabetes and obesity, and are thought to have a 10 percent to 20 percent chance of a heart attack or cardiac death within 10 years, under 130.
The guidelines, presented to the general public earlier this month, are not new to cardiologists.
"We've been following the studies. We knew the trend was downward. We've been attempting to get patient LDL levels between 70 and 80 for some time," said Dr. Joseph J. Millan, with Regional Cardiology Associates in Sharon, Pa.
Bottom line
The bottom line is, "the lower the LDL, the lower the risk of a cardiac event or stroke," said Dr. J. Ronald Mikolich, chief of cardiology at Northeastern Ohio Universities College of Medicine.
The data is overwhelming, Dr. Mikolich said. The real issues are patient compliance with doctor recommendations and the cost of medications. There is a need to monitor patients on a ongoing basis, he said.
It will be difficult, but reaching the new guidelines is "absolutely" doable, said Dr. Millan, affiliated with Sharon Regional Health System in Sharon.
However, he said, it will most likely require a combination of several drugs to achieve those lower levels, as well as patient lifestyle changes.
Other factors
Drugs are just one part of multifaceted treatment. Other factors to consider are diet, weight reduction, blood pressure control, family history, level of regular exercise and quitting smoking, said Dr. Mikolich, who is affiliated with St. Elizabeth Health Center and has a private practice in Youngstown.
One known way to help lower LDL to the new levels is the use of the statin family of drugs, such as Lipitor, to block formation of cholesterol, in combination with drugs that block cholesterol from entering the blood.
Drugs alone are not the answer, but that there are fewer heart events when using statins is proven clinically, Dr. Millan said.
"Even small doses, such as 10 mg, lowers the risk of a heart event. Also, any diabetic should be treated as aggressively as if they had already had a heart event," he said.
The lower the better
It is known that the lower the LDL level, the better. In populations with under 65 LDL, there is virtually no coronary disease compared to what is seen in this country. Their diets are low in saturated fats, said Dr. David N. Fredericka, solo practitioner with Cardiac Management in Warren.
Dr. Mikolich said one problem has been over-reporting of the risks associated with higher levels of statins and other drugs, resulting in patients resisting using the drugs.
Statins are generally well tolerated, with only about 3 percent of patients having side effects that require discontinuing the drug, Dr. Mikolich said.
Dr. Fredericka, a clinical cardiologist who emphasizes prevention, said: "Almost every patient that has coronary disease is doing something wrong in their diet. And [they don't] exercise."
alcorn@vindy.com