Heartsick America

We've just had our heart checked, and the news isn't good. According to a federal report released last week, some 36 million Americans should now be taking drugs to lower their cholesterol. That's nearly three times the 13 million who qualified for treatment under the government's previous guidelines. Why the change? Not because we're actually sicker than before, says Dr. Claude Lenfant of the National Heart, Lung, and Blood Institute, but because the benefits of cholesterol reduction are so clear. "We can now say with certainty that lowering a high blood cholesterol level dramatically reduces a person's risk for coronary heart disease," Lenfant declared last week.

Unlike the previous guidelines, the new ones recommend different limits on LDL (the bad cholesterol) for different groups of people. How low does your count need to be? It depends on your age, sex and family history, and on risk factors, such as smoking, obesity and high blood pressure. Some of these carry more weight than others, but each of them gives you another reason to worry about your cholesterol. According to the new guidelines, a person with only one heart-attack risk factor can live comfortably with an LDL score of 160 (in mg per deciliter of blood). But folks with two or more risk factors require a lower LDL score (130), and those already suffering from diabetes or heart disease need to aim even lower (100). Anyone whose score creeps 30 points out of his or her target zone is automatically a candidate for medication.

Drugs like Mevacor and Pravachol have few side effects, and no one denies they prevent heart attacks by lowering LDL. But some experts question whether $800-a-year drug regimens are the best solution to a problem affecting such a huge number of people. Though the guidelines include diet and lifestyle recommendations, they assume medication is the only way to achieve major cholesterol reductions. "When you make big [lifestyle] changes you see big effects," says Dr. Dean Ornish of the Preventive Medicine Research Institute. "And it costs nothing." Either way, the take-home message is clear. It pays to know your LDL--and control it by any means necessary.