Updated optional cholesterol goals hard to reach

Recently updated "optional" goals set by the National Cholesterol Educational Program (NCEP) for "bad" low-density lipoprotein cholesterol (LDL-C) are not being met by many millions of Americans, researchers report in the February issue of the Journal of General Internal Medicine.

"To reap the benefits we know are possible," lead investigator Dr. Stephen D. Persell told Reuters Health, "many more people with intermediate or high risk of heart disease will need to adopt lifestyle changes and use medication to reduce their cholesterol."

Persell, of Northwestern University, Chicago and colleagues came to this conclusion after a study using 1999-2002 data from more than 3200 participants in the National Health and Nutritional Examination Survey.

In all, 30 percent had LDL-C levels beyond those recommended by the NCEP in 2001. For the revised optional 2004 goals, the corresponding proportion was roughly 36 percent.

For example, in moderate cardiovascular risk patients, the goal was below 130 mg/dL in 2001. In 2004, this goal had fallen to an optional 100 mg/dL in these patients.

The researchers estimated that about 25 million people exceeded 2001 thresholds for drug therapy and 46 million exceeded optional 2001 thresholds for drug therapy. For 2004 optional thresholds, the corresponding figure was more than 56 million.

With changing targets, Persell said in a statement, "the gap between what we believe to be ideal goals and what has been achieved gets even wider."

This appears to be particularly true of those at moderately high or high risk of cardiovascular disease. Optional 2001 goals for drug therapy were exceeded by roughly 56 percent of those at moderately high risk and 72 percent of people at high risk. Using the revised 2004 standards, the proportions were 87 percent and 96 percent.

"So, many people have excessive risk that could be reduced by lowering the level of 'bad' cholesterol," Persell said.

However, the researchers point out that significant numbers are unlikely to achieve optimal NCEP LDL-C goals with standard-dose statins. Furthermore, the investigators conclude, "Current costs of these drugs may place them out of reach for many patients likely to benefit."

SOURCE: Journal of General Internal Medicine, February 2006.