I am a dialysis RN with a 235 ldl cholesterol level - I watch what i eat and have lost 35 pounds since giving birth 3+ months ago - is there anything I should be doing or watching out for at this time?

I was just given this information at my facility. It may help:


NCEP ISSUES MAJOR NEW CHOLESTEROL GUIDELINES
>
> The National Cholesterol Education Program (NCEP) today issued major
> new
> clinical practice guidelines on the prevention and management of high
> cholesterol in adults. The guidelines are the first major update from
> NCEP in nearly a decade.
>
> NCEP, which is coordinated by the National Heart, Lung, and Blood
> Institute (NHLBI), develops new guidelines as warranted by research
> advances. Earlier guidelines were issued in 1988 and 1993. An executive
> summary of the new guidelines, the �Third Report of the NCEP Expert
> Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol
> in Adults,� also known as Adult Treatment Panel (ATP) III, appears in
> the May 16, 2001, issue of the Journal of the American Medical
> Association.
>
> Key changes in the new guidelines are: 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
> known
> as �the metabolic syndrome;� and increased attention to the treatment
> of
> high triglycerides.
>
> The new guidelines are expected to substantially expand the number of
> Americans being treated for high cholesterol, including raising the
> number on 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.
>
> �Americans at high risk for a heart attack are too often not identified
> and, so, don�t receive sufficiently aggressive treatment,� said NHLBI
> Director Dr. Claude Lenfant. �Yet, studies show conclusively that
> lowering the level of low-density lipoprotein, or LDL, the �bad
> cholesterol,� can reduce the short-term risk for heart disease by as
> much as 40 percent. Treatment may lower risk over the long-term-that
> beyond 10 years-even more. That�s why, while the intensity of treatment
> in ATP III is stepped up, its primary aim remains squarely on lowering
> LDL.�
>
> According to ATP III, Americans at high risk for a heart attack include
> those with heart disease or diabetes, and many of those with multiple
> heart disease risk factors. The guidelines state that diabetes poses as
> great a 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.
>
> To better identify risk, the guidelines include a tool that predicts a
> person�s chance of having a heart attack within 10 years. Based on
> newly
> analyzed data from the landmark, NHLBI-supported Framingham Heart
> Study,
> the �risk assessment tool� translates clinical conditions and lifestyle
> factors into a single, easy-to-understand category of risk. 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. ATP III
> recommends use of the tool for persons with two or more heart disease
> risk factors.
>
> �The new guidelines will help doctors determine heart attack risk more
> precisely than was possible before,� said Dr. Scott Grundy, ATP III
> chairperson and director of the Center for Human Nutrition at the
> University of Texas Southwestern Medical Center at Dallas. �That allows
> treatment to be more individualized. We now know that
> cholesterol-lowering treatment is more effective when its intensity
> closely matches the level of risk.�
>
> �The ATP III approach looks at �overall� risk for a heart attack,� said
> NCEP Coordinator Dr. James Cleeman, �which means in the short- and
> long-term. That�s important because, although risk typically increases
> with age, the foundation for heart disease is often laid in adolescence
> and early adulthood. So Americans need to act now to prevent that
> future
> heart attack or heart disease itself. Every risk factor needs to be
> treated.�
>
>
> Cleeman advises Americans to check with their doctor to learn their
> overall risk for a heart attack and what, if any, treatment is needed.
>
>
> Other changes in the new guidelines include:
>
> Treating high cholesterol more aggressively for those with
> diabetes.
>
> Besides their very high short-term risk for having a coronary
> event, persons with Type 2 diabetes also have a particularly
> high risk of dying from a heart attack. Type 2 diabetes, or
> noninsulin-dependent diabetes mellitus, is the most common
> form of the disease and affects more than 14 million
> Americans.
> A lipoprotein profile as the first test for high cholesterol.
>
> A lipoprotein profile measures levels of LDL, total
> cholesterol, HDL, and triglycerides, another fatty substance
> in the blood. The prior recommendation called for initial
> screening with a test for only total cholesterol and HDL. The
> guidelines advise healthy adults to have a lipoprotein
> analysis once every 5 years.
> A new level at which low HDL becomes a major risk factor for
> heart disease.
>
> ATP III defines a low HDL as being less than 40 mg/dL.
> Previously, a low HDL was less than 35 mg/dL. The change
> reflects new findings about the significance of a low HDL,
> and
> the strong link between a low HDL and an increased risk of
> heart disease. An HDL level of 60 mg/dL or more is considered
> protective against heart disease.
> Intensified use of nutrition, physical activity, and weight
> control in the treatment of elevated blood cholesterol. ATP III
> combines these steps into a new �Therapeutic Lifestyle Changes�
> (TLC) treatment plan.
>
> ATP III recommends a more intense and effective eating plan
> than that previously used. The new diet reflects changes in
> Americans� eating habits, including a drop in saturated fat
> and cholesterol consumption. The new TLC diet includes daily
> intakes of less than 7 percent of calories from saturated fat
> and less than 200 mg of dietary cholesterol. It also allows
> up
> to 35 percent of daily calories from total fat, provided most
> is from unsaturated fat, which doesn�t raise cholesterol
> levels. (A higher fat intake may be needed by some patients
> with high triglycerides and/or a low HDL to keep their
> triglycerides or HDL from worsening.)
>
> ATP III also encourages use of certain foods that contain
> plant stanols and sterols, or are rich in soluble fiber, to
> boost the diet�s LDL-lowering power. Plant stanols and
> sterols
> are included in certain margarines and salad dressings; foods
> high in soluble fiber include cereal grains, beans, peas,
> legumes, and many fruits and vegetables.
>
> Additionally, the guidelines stress the need for weight
> control and physical activity, both of which improve various
> heart disease risk factors. For instance, weight control
> enhances LDL lowering and raises HDL, while physical activity
> improves HDL and, for some, LDL. �TLC is the first line of
> therapy for high cholesterol and, with the turbo-charge that
> ATP III gives it, it will be significantly more effective in
> lowering LDL than the previous lifestyle recommendations,�
> said Cleeman.
> Identifying a �metabolic syndrome� of risk factors linked to
> insulin resistance, which often occur together and dramatically
> increase the risk for coronary events.
>
> The syndrome includes factors such as too much abdominal fat
> (indicated by too large a waist measurement), elevated blood
> pressure, elevated triglycerides, and low HDL. Therapy for
> the
> syndrome emphasizes TLC, especially weight control and
> physical activity. Insulin controls the body�s metabolism of
> carbohydrates, fats, and protein. In insulin resistance, its
> normal actions are impaired. �The metabolic syndrome has
> emerged as being as strong a contributor to early heart
> disease as cigarette smoking,� said Grundy. �In addition, the
> insulin resistance that goes along with the syndrome is one
> of
> the underlying causes of Type 2 diabetes. It�s thus very
> important to recognize the syndrome and treat it with
> lifestyle changes.�
> More aggressive treatment for elevated triglycerides.
>
> Recent studies indicate that an elevated triglyceride level
> is
> significantly linked to the degree of heart disease risk. The
> new guidelines recommend treating even borderline-high
> triglyceride levels. Therapy includes weight control and
> physical activity and sometimes, for higher triglyceride
> levels, medication.
> Advising against the use of hormone replacement therapy (HRT) as
> an alternative to cholesterol-lowering drugs.
>
> According to ATP III, studies have not shown that HRT reduces
> the risk for major coronary events or deaths among
> postmenopausal women who have heart disease. HRT also
> increases the risk for thromboembolism and gallbladder
> disease. In contrast, cholesterol-lowering drugs have been
> found to reduce coronary events in women with or without
> heart
> disease.
>
> Founded in 1985, NCEP seeks to reduce the prevalence of high blood
> cholesterol among Americans. It is a multidisciplinary coalition with a
> Coordinating Committee comprised of representatives from more than 40
> major medical and health professional associations, voluntary health
> organizations, community programs, and governmental agencies.
>
> The new guidelines were developed over 20 months by 27 panel members
> and
> consultants who are leading experts in heart disease, lipid measurement
> and management, primary care medicine, nutrition, epidemiology, health
> economics, and other areas. The guidelines were reviewed and approved
> by
> NCEP�s Coordinating Committee. NHLBI is part of the National Institutes
> of Health, located in Bethesda, MD.
>
> To arrange an interview with Cleeman, contact the NHLBI Communications
> Office at (301) 496-4236. Also available from the NHLBI Communications
> Office is a b-roll with soundbites. There will be the following
> satellite feeds of the b-roll: May 15, 2001, 2 p.m. to 2:15 p.m.
> Eastern, Telstar 4, Transponder 6, DL 3820, C-Band; May 16, 2001, 1:15
> p.m. to 1:30 p.m. Eastern, Telstar 5, Transponder 16, DL 4020, C-Band.
>
> To interview Grundy, contact Amy Shields, University of Texas
> Southwestern Medical Center�s Office of News and Publications, at (214)
> 648-3404.
>
> The following ATP III and cholesterol-related materials can be found
> online:
> The guidelines� executive summary and �At A Glance� desk reference for
> physicians
> <http://www.nhlbi.nih.gov/guidelines/cholesterol/atp_iii.htm>
> ;
> an interactive version of the guidelines for PalmOS� devices <
> http://hin.nhlbi.nih.gov/atpiii/atp3palm.htm>;
> a patient brochure, �High Blood Cholesterol-What You Need To Know� <
> http://www.nhlbi.nih.gov/health/public/heart/index.htm>;
> a 10-year heart attack risk calculator <
> http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof>;
> and a �Live Healthier, Live Longer� Web site <
> http://www.nhlbi.nih.gov/chd/index.htm> for patients and the public.
> To get these items, go to the NHLBI home page <
> http://www.nhlbi.nih.gov/index.htm> (at www.nhlbi.nih.gov) and click on
> ATP III Cholesterol Guidelines under Highlights.
>
>
>
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