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Study Finds Both Prevention and Treatment Needed to Control Heart Disease

Both prevention and drug treatment strategies are needed to control cholesterol and reduce the risk of death from heart disease, a Wake Forest University investigator reported today (Nov. 10) at the American Heart Association meeting in Atlanta.

David C. Goff, Jr.,M.D., Ph.D, and his colleagues looked at total cholesterol records in people born as long ago as 1887, using four major national health surveys totaling 49,536 people - the first dating from 1962 and the last completed in 1994.

At lower levels of total cholesterol, only diet typically is needed to keep cholesterol under control or bring the number down. Only when total cholesterol gets very high - at least 240 - do doctors turn to drugs to reduce cholesterol.

The combined strategies seem to be working. Cholesterol reduction showed up across the surveys. The reduction was not restricted to people with high cholesterol levels. Rather the cholesterol levels seen among people with the lowest cholesterol levels had been dropping also.

The decreases seen at the lower levels support the contention that a strong prevention effect occurred in the United States," said Goff, associate professor of public health sciences (epidemiology) and internal medicine (general internal medicine.) "The larger decrease in the upper range may reflect the combined effects of prevention and treatment."

In looking across the four surveys, Goff found that cholesterol levels were lower in people born more recently than in people born earlier in this century or at the end of the last century.

Cholesterol reduction programs generally began about two decades ago, along with control of two other risk factors for heart disease - high blood pressure and smoking. Though heart disease remains the leading killer of Americans, the heart disease death rate has been declining over the past several decades.

"These findings support the potential utility of planned population approaches to risk factor reduction and chronic disease prevention," Goff said.

In other words, in addition to efforts by physicians on their own patients, community and national campaigns could be used to encourage people to control their cholesterol - a broadening of the community-wide cholesterol screening campaigns of a decade ago.

Goff said, "Efforts aimed at preventing the development of high blood cholesterol through changes in health behaviors at the population level should go forward simultaneously with continued and intensified effort to improve the control of high blood cholesterol through medications."

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