Recommended cholesterol level may be too high

Many patients who suffer a heart attack have levels of “bad” LDL cholesterol well below recommended limits, supporting efforts to revise current guidelines to include lower target levels, new research shows.

“The conventional cholesterol guidelines are missing the majority of patients” who have heart attacks and related problems, Dr Gregg C. Fonarow said.

“This should serve as a wake-up call for anyone interested in reducing death and disability due to cardiovascular disease,” added Dr Fonarow, who is director of the Ahmanson-UCLA Cardiomyopathy Centre, Los Angeles.

Using data from the national Get With The Guidelines database, Dr Fonarow and colleagues analysed information on more than 230,000 patients hospitalised for heart attacks and related problems at 541 hospitals between 2000 and 2006.

Nearly half of the patients hospitalised with a heart attack had LDL levels less than 100 milligrams per decilitre, and about 18 per cent had LDL levels below 70 milligrams per decilitre, according to the report in the American Heart Journal. Current guidelines recommend these levels as suitable targets for high-risk individuals.

Among subjects with no history of heart disease or diabetes, 72 per cent had LDL levels less than 130, the current LDL target for these individuals, and about 42 per cent had LDL less than 100.

“The findings in this study are quite a surprise,” Dr Fonarow said. Previous smaller studies suggested that only half the patients having a heart attack had LDL cholesterol levels less than 130. These new data “suggest it is more like 75 per cent of patients.”

The researchers also found that 55 per cent of patients had “good” HDL cholesterol levels below 40 milligrams per decilitre and fewer than 10 per cent had “ideal” HDL levels of 60 or greater.

Before they ended up in the hospital, only 21 per cent of patients were taking cholesterol-lowering drugs.

“These findings may provide further support for recent guideline revisions with even lower LDL goals and for developing effective treatments to raise HDL,” the investigators conclude.

Reuters Health

Source: American Heart Journal, January 2009