Cholesterol Alert

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Should you be taking drugs to lower your cholesterol? For millions of Americans who never dreamed they had a heart condition, the answer to that question changed abruptly last week. Impressed by mounting evidence that aggressive treatment can significantly reduce death from heart disease, a panel of experts from the National Heart, Lung and Blood Institute issued new guidelines for treating high cholesterol. In one stroke, the panel nearly tripled--from 13 million to 36 million--the number of adults who should be taking daily doses of powerful cholesterol-lowering drugs. They also raised by 25%--from 52 million to 65 million--the number who should go on a cholesterol-lowering diet.

Think of it as a remake of a Hollywood movie starring a cast of familiar characters: the good cholesterol (HDL), the bad (LDL) and the ugly (heart disease). The heroes are diet, exercise and a class of drugs called statins that cut cholesterol levels sharply by blocking a liver enzyme involved in cholesterol production.

What should you do? The first step is to get tested, early and often. Beginning at age 20 and every five years thereafter, all adults--even if they don't show signs of disease--should have their blood screened to get a lipoprotein profile (HDL, LDL, total cholesterol and triglycerides).

The last time guidelines were issued was eight years ago; since then we've learned a great deal about the role of HDL, the "good" cholesterol. A level of 60 or more is still considered to be protective against heart disease, but now we know low levels can also be dangerous. Before, doctors believed we should have a minimum level of 35. Now the bar has been raised to 40.

LDL has always played the heavy, the bad guy behind the buildup of fatty plaque in the arteries. The revised recommendations draw new lines in the sand. The optimal level is 100. Levels above 190 are off the charts. But even borderline (101 to 129), high-borderline (130 to 159) and high levels (160 to 189) can benefit from treatment.

Triglycerides, free-floating molecules that circulate in our blood transporting fats for storage and metabolism, were given short shrift eight years ago. But recent studies show that elevated triglyceride levels significantly increase risk of heart disease. It's now recommended that even borderline-high triglyceride levels (150 to 199) be treated through weight control and physical activity and, in extreme cases, with drugs.

How do you find out where you stand? Once you have your test results, calculating your level of risk is fairly straightforward. The National Institutes of Health has devised a formula that weighs the factors and tells you how likely you are to have a heart attack in the next 10 years. Easy-to-use computerized versions of this formula can be found at various websites, including time.com (see below).

If you fall in a needs-treatment category, your doctor can tell you whether you are a candidate for cholesterol-lowering drugs. Aggressive treatment does not mean drugs alone. You may also need to increase your physical activity, eat more fiber-rich foods and cut back on saturated fats and cholesterol. These are familiar recommendations, but now they apply to a lot more people.

You can test your risk of heart disease at time.com/cholesterol. Also see the American Heart Association.

Dr. Ian is a medical correspondent for NBC's Today show.