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Heart Smart

updated 06/25/2001 AT 01:00 AM EDT

originally published 06/25/2001 AT 01:00 AM EDT

When it comes to cholesterol and heart disease, Dr. Scott Grundy does not sugarcoat his message. "Americans are not in good shape," he says. "They eat too many saturated fats and they're overweight."

Grundy is chairman of the National Cholesterol Education Program, a 27-member panel of physicians that recently released new and controversial guidelines for the treatment of high cholesterol, which is directly linked to heart disease, the No. 1 killer of Americans, which will claim half a million lives this year alone. In its first report since 1993, the group proposes nearly tripling—to 36 million—the number of adults who should be taking cholesterol-lowering drugs. The group also recommends raising by 25 percent—to 65 million—the number of Americans who should be on a cholesterol-lowering diet. "Based on the statistics and the lifestyles of Americans," says Grundy, 67, "this aggressive plan of attack is a necessity."

Grundy, who is also director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center, lives in Dallas with Lois, his wife of 39 years. He spoke with correspondent Chris Coats.

What is cholesterol?

It's a fatty substance, manufactured in the liver, which is carried in blood and is used for producing hormones, bile acids for digesting food, and vitamin D. Cholesterol is found in cells throughout the body, including the heart, liver, skin and muscle, and it's necessary to keep the body functioning normally.

What are the different kinds of cholesterol?

Since cholesterol is a fatty substance and blood is a watery substance, the two, like oil and water, don't mix. And so in order to travel through the blood-stream, cholesterol must combine with a protein to create protective packages, called lipoproteins. These come in three kinds: high density lipoproteins (HDL), low density lipoproteins (LDL) and very low density lipoproteins (triglycerides).

Which one is the bad cholesterol?

The LDL cholesterol. When too much LDL is in the blood, it accumulates and injures arteries by clogging them with plaque, a thick, hard deposit made up of cholesterol and scar tissue. Plaque blocks blood flow and oxygen to the heart muscle, which eventually can lead to a heart attack or stroke.

So HDL is the good cholesterol?

Yes. HDL keeps cholesterol from accumulating in the artery walls by taking it away and cleaning up the arteries. HDL also sweeps the cholesterol from other parts of the body back to the liver, where it can be gotten rid of.

Why are doctors now paying more attention to triglycerides?

Triglycerides are another fatty substance that are carried in lipoproteins. They are a major energy source for the body. Recent studies show that elevated triglyceride levels significantly increase the risk for heart disease.

What are blood cholesterol levels?

An individual's blood cholesterol level includes LDL, HDL and triglycerides.

What do the numbers mean?

For LDL cholesterol, less than 100 is the optimal level and less than 130 is near optimal for most people. An HDL level less than 40 is of concern and may indicate an increased risk for a heart attack. A triglyceride level greater than 150 may also indicate increased risk. What's important is that anyone who has had a heart attack or is at high risk needs to have an LDL at the optimal level.

How often should cholesterol levels be checked?

At least once every five years beginning at age 20, which is when plaque starts to build up more readily. Those who have a history of heart disease or have had a heart attack previously, as well as those with other high-risk factors—including people who suffer from diabetes and smokers—should probably have themselves checked several times a year.

How can bad cholesterol be reduced?

Go easy on saturated fats and animal fats, including fatty meat, butter, cheese and milk, which are artery doggers because they go into the liver and elevate the body's LDL level. Eat vegetables and whole grains.

What about eggs, which have long been associated with high cholesterol?

Eggs are high in cholesterol and should still be limited in the diet. The American Heart Association recommends eating less than 300 milligrams of cholesterol daily—one egg contains about 215 milligrams.

What helps boost HDL cholesterol?

Use vegetable oils like olive and canola rather than hard fats like butter. Exercise regularly and lose weight. If you smoke, quit.

What if the LDL levels still remain high?

More aggressive treatment may be needed. In addition to lifestyle changes, the patient may need cholesterol-lowering drugs, such as statins, which cut cholesterol levels dramatically by blocking a liver enzyme crucial to cholesterol production.

If these drugs are effective in cutting cholesterol levels, is it still imperative to eat a heart-healthy diet?

Yes. These drugs reduce the risk of heart attack by 40 percent, but people who take them are still at risk. So diet and exercise are still extremely important.

Do these drugs pose health risks?

In rare cases, they can be toxic to the liver or muscle, so it's important to have periodic blood tests. But most people have no significant side effects. Our goal is to keep decreasing heart disease significantly in America.

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