According to 1999 estimates, nearly 960,000 Americans die from heart disease and stroke each year, making cardiovascular disease (CVD) the leading cause of death in this country. Reducing cholesterol lowers the risk of CVD. According to the most recent statistics, if all forms of major CVD were eliminated, life expectancy would rise almost seven years, says Robert Bonow, M.D., American Heart Association president.
While CVD is often perceived as a disease of older age, about half of people diagnosed with CVD and about 15 percent of those who die from CVD are younger than age 65, notes Bonow, who is also chief of cardiology at Northwestern University Medical School in Chicago. "Of greater significance, many young adults with no clinical evidence of CVD have two or more risk factors that predispose them to heart attacks, strokes and death over the course of several decades," he says. "Unfortunately, in apparently healthy young people, these risk factors usually go unrecognized and untreated."
This must change, Bonow says, in light of compelling evidence that much of cardiovascular disease is totally or partially preventable. "To make a real difference in the epidemic, we need to look at ways of preventing heart disease and stroke in these apparently healthy persons at high risk," he says. "This is what the updated National Cholesterol Education Program (NCEP) guidelines are all about."
The NCEP's Adult Treatment Panel III recommendations, issued last year, placed a new focus on primary prevention in people with multiple risk factors who have not yet shown signs of CVD. In July 2002, the American Heart Association updated its primary prevention guidelines, which are consistent with those of the NCEP.
Both sets of guidelines stress that multiple risk factors pose as great a risk of heart attack or death in 10 years as heart disease itself. Furthermore, the risk from diabetes alone can be equally great. Clearly, patients with these problems should be treated as intensively as those with existing heart disease, Bonow says.
Treatment should go beyond reducing low-density lipoprotein (LDL) to include aggressive treatment of elevated triglycerides, high blood pressure and metabolic syndrome – a constellation of major risk factors that includes high triglycerides, abdominal obesity, low high-density lipoprotein (HDL), high blood pressure and insulin resistance.
Above all, we advocate a healthy lifestyle approach for people with multiple risk factors, Bonow says. This means reducing saturated fats to less than 7 percent of total calories and lowering cholesterol consumption to less than 200 milligrams a day. Americans also should increase intake of plant stanols and sterols – beneficial micronutrients found in plants – to two grams a day, lose weight when necessary and increase physical activity.
If the NCEP and American Heart Association recommendations were followed, the number of Americans being treated for high cholesterol with dietary treatment would increase from about 52 million to about 65 million and the number who are prescribed a cholesterol-lowering medication would increase from about 13 million to about 36 million.
"It is impossible to estimate the impact of following the primary prevention guidelines on CVD mortality rates, but . . . it is clear these strategies could save lives."
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