Cholesterol Management

Lipid lowering therapy reduces the risk of stroke. Researchers recently published a study showing the beneficial effects of cholesterol reduction on stroke ( White et al, New England J Med 2000;343:317 ). Compared to placebo, Pravastatin (Pravachol) was associated with a 23% reduction in non-bleeding stroke (4.4 vs 3.4%). There was no significant change in the incidence of bleeding (hemorrhagic) stroke between the 2 groups.

There is now abundant information to support the practice that aggressive risk factor modification and lowering of serum cholesterol is not only beneficial for 'secondary' prevention in patients with known atherosclerosis (coronary artery disease, stroke, claudication, peripheral vascular disease) but that achieving optimal cholesterol levels is also quite important for 'primary' prevention in patients without documented atherosclerosis particularly for those who have risk factors for vascular disease (high blood pressure, smoking, diabetes, family history of premature coronary artery disease).

It is estimated that there are 5-6 million Americans with coronary heart disease who should be treated with cholesterol lowering medications. But, only about one-third receive such treatment and even fewer are treated to the appropriate target LDL level. Every 10% reduction in cholesterol translates into a 12-16% decrease in mortality for patients with coronary artery disease.

LDL is recognized as the primary target for lipid lowering therapy.

LDL Level	Classification
<100	Optimal
< 130 mg/dl	Desirable
130-159 mg/dl	Borderline
> 160 mg/dl	High

Regardless of whether medication is needed to control your cholesterol, proper dietary modification is important. Most foods available in the United States now come with a label attached to the box or package detailing their fat and calorie content. Read more about Understanding Food Labels, Fat Content , and the Mediterranean Diet . Accordingly, the National Cholesterol Education Program has set the following parameters for the drug treatment of high cholesterol:

PATIENT CATEGORY	Drug Treatment for LDL:	Target LDL
PRIMARY PREVENTION- No Heart Disease	.	.
< 2 Risk Factors	>190	<160
2 or More Risk Factors	>160	<130
SECONDARY PREVENTION	.	.
Known Coronary Disease	>130	<100

These recommendations should be individualized, particularly for younger patients and pre-menopausal women. Diabetic patients are generally treated very aggressively. Please consult your doctor for further recommendations.

We can help you with cholesterol measurement and appropriate diet management and drug therapy. Our Oak Lawn, LaGrange , and Hinsdale offices are equipped with cholesterol measuring machines that are capable of determining a complete lipid profile in a matter of minutes from a simple finger stick while you wait. The test is best done after a 4-8 hour fast. (We can also perform Protime measurements for Coumadin patients in the office from a similar finger stick)