Features April 2009 Issue

Reducing Heart Attack Risk May Take More Than Reaching Cholesterol Goals

A healthy lifestyle and more aggressive, individualized cholesterol management are needed, especially if you are at high risk for a cardiovascular event.

If you’ve been taking statins, watching your diet, exercising and following your doctor’s other orders to get your cholesterol under control, you should feel good about lowering your heart attack risk. But even if you’ve reached your LDL ("bad") cholesterol target levels, recent research suggests you may still need to go lower and take even further steps to protect yourself. A national study of more than 136,000 patients, published in the January issue of the American Heart Journal, found that nearly 75 percent of those hospitalized for a heart attack had LDL levels that would indicate they were not at high risk for a cardiovascular event, based on national cholesterol guidelines. LDL cholesterol can form dangerous plaques in the arteries, which can then rupture, leading to a heart attack or stroke. "The findings are both encouraging and discouraging at the same time," says cardiologist Stephen Nicholls, MD, Clinical Director of the Cleveland Clinic Center for Cardiovascular Diagnostics and Prevention. "The good aspect is that we’re seeing more patients with LDL levels below our current targets. This is good and suggests we’re making incredible progress, given the clear link between elevated LDL levels and heart disease. The sobering thought is that it’s not nearly enough." Current guidelines call for people considered high risk to have LDL levels of less than 100 mg/dl, while "very high risk" patients are urged to reach levels less than 70 mg/dl. Moderate risk patients have a target of less than 130 mg/dl.

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