What's High Cholesterol?

You've probably had a cholesterol test. And if your total cholesterol level approached 240, you were no doubt warned to bring it down through diet or drugs. That's usually sound advice, but two new studies suggest the need for subtler strategies to ward off heart disease.

It's no secret that cholesterol comes in good and bad varieties (HDL and LDL). Current federal guidelines advise doctors to measure people's total cholesterol or their bad cholesterol (LDL) and to recommend treatment accordingly. But a study published in the Nov. 1 Annals of Internal Medicine shows that people with low cholesterol counts can still be at risk if they're short on HDL. By measuring the ratio of total cholesterol to HDL among 8,000 subjects from past studies, researchers at the University of Pennsylvania managed to predict 15 percent more heart disease than the stand-ard approach would have caught. The study won't immediately affect federal guidelines, but individual doctors may want to update their tool kits.

In a separate study, published in the Journal of the American Medi-cal Association, Yale researchers report that high cholesterol -- however it's measured -- holds no apparent risk for people over 70. The Yale team spent four years tracking 997 elderly Connecticut residents who got cholesterol tests in 1988. Those with the worst profiles had virtually the same rates of heart disease and death as those with the best profiles.

Under the government's current guidelines -- based largely on studies of middle-aged men -- some 18 percent of elderly women and 12 percent of elderly men would qualify for cholesterol-lowering drugs. But as epidemiologists Stephen Hulley and Thomas Newman observe in a commentary on the new study, ""policies that make sense in one age group may not be justified in another.'' Until someone shows that high cholesterol is dangerous in old folks, they may want to skip an occasional dose of lovastatin and down a fried egg.