Scott Carollo, M.D , Cardiologist with the Alegent Health Heart and Vascular Institute

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Q: My doctor tells me that I have high cholesterol, but I'm not sure I understand the terms HDL and LDL. What's normal, and when should I be concerned?

A: On May 15, 2001 the National Cholesterol Education Program (NCEP) issued major new clinical practice guidelines in the prevention and management of high cholesterol in adults. The guidelines are the first major update from NCEP in nearly a decade.

Current guidelines list 200 milligrams per deciliter of total cholesterol as the desirable level, over 240 as high, and less than 35 milligrams of HDL as too low.

The new guidelines remain the same for total cholesterol, but add that 100 milligrams of LDL is optimal. The NIH lists 130-159 as borderline high, 160 as high, and 190 as very high. The minimum reading for HDL rises from 35 to 40 milligrams.

The new guidelines are expected to substantially expand the number of Americans being treated for high cholesterol, including raising the number of dietary treatment from about 52 million to about 65 million and increasing the number prescribed a cholesterol-lowering drug from about 13 million to about 36 million.

Key changes in the new guidelines

• more aggressive cholesterol-lowering treatment and better identification of those at high risk for a heart attack
• use of a lipoprotein profile as the first test for high cholesterol
• a new level at which low HDL (high-density lipoprotein) becomes a major heart disease risk factor; a new set of "Therapeutic Lifestyle Changes," with more power to improve cholesterol levels
• a sharper focus on a cluster of heart disease risk factors knows as " the metabolic syndrome"
• increased attention to the treatment of high tryglycerides
• advising against the use of hormone replacement therapy (HRT) as an alternative to cholesterol lowering drugs

Americans at high risk for a heart attack include those with heart disease, and many of those with multiple heart disease risk factors. The guidelines state that diabetes poses a great risk for having a heart attack in 10 years as heart disease itself-and the threat from multiple risk factors can be equally great. The guidelines recommend these persons be treated as intensively as heart disease patients with lifestyle changes and medication.

New Assessment Tool Considers Many Factors

The guidelines include a "risk assessment tool." The tool calculates risk separately for men and women based on age, total cholesterol, HDL (the "good " cholesterol), systolic blood pressure, treatment for high blood pressure, and cigarette smoking.