Doctor always knows best, right?
That may not be true when treating high cholesterol, a major cause of heart disease-America`s No. 1 killer.
A 1986 national survey shows the public is more aware than doctors that lowering cholesterol has a major impact in preventing heart disease.
Less than two-thirds of doctors believe cholesterol has a large effect on heart disease-even though good scientific evidence established this in 1984, according to the National Heart, Lung and Blood Institute.
As a result, doctors have not been aggressive enough in testing and treating healthy adults to prevent heart attacks, which strike 1.5 million Americans annually, said Dr. Rodman D. Starke, chairman of an American Heart Association task force on cholesterol.
This delay in recognizing the impact of cholesterol is a major reason why a quarter of American adults-more than 40 million people-have cholesterol levels putting them at high risk, said Starke, chief of cardiology at Davies Medical Center in San Francisco.
Probably fewer than half are receiving any type of treatment-and a very small minority are receiving effective treatment, said Dr. DeWitt Goodman, a Columbia University heart disease expert.
It is a situation that makes millions of Americans victims of a progressive and silent disease that causes 540,000 heart attack deaths a year, including many who have no warning symptoms and two-thirds who die before reaching a hospital.
But experts predict this is about to change.
GUIDELINES FOR TREATMENT
For the first time, the federal government recently announced precise guidelines for treating healthy adults for high cholesterol and launched a national campaign to educate the nation`s 150,000 practicing doctors.
``The potential for saving lives is enormous,`` said Dr. Robert Levy, former director of the National Heart, Lung and Blood Institute.
The national education program could save 100,000 to 150,000 lives a year ``by very reasonable estimates,`` according to Goodman, chairman of the panel of national experts that drafted the recommendations.
The figures are based on estimates that aggressive dietary treatment could reduce cholesterol levels by an average of 10 percent to 15 percent, producing a 20 percent to 30 percent reduction in heart attacks and deaths, Goodman said.
The strict new guidelines could affect as many as 100 million American adults whose total cholesterol levels exceed the goal of under 200 milligrams per deciliter, Levy said.
In summary, the guidelines recommend that:
- Starting at age 20, all adults should be tested every five years.
- A total level of 240 or higher indicates high risk for heart disease and requires aggressive treatment with diet and, if necessary, drugs.
- A total level of 200 to 239 is borderline high-risk. Treatment is required if the patient has heart disease or has two or more risk factors. These include being male, smoking or having high blood pressure and a family history of premature heart disease.
Ohio family practice physician Dr. Martin Loftus said the guidelines would encourage aggressive action because ``doctors now have precise, well-thought-out instructions on when and how to treat patients.``
Previously, many doctors were reluctant to treat patients because there was widespread controversy over what levels were dangerous, the role of risk factors and when to use drugs as opposed to diet, Loftus said.
The result was that treatment was inconsistent: Many doctors didn`t act until cholesterol reached dangerously high levels of 260 or even 300; some patients received drugs unnecessarily; and millions more were never tested, experts said.
``Now we can go to reluctant doctors and say, `The evidence is here and we should move on it,``` Starke said.
KNOW YOUR LEVEL
Every adult should know his cholesterol level, he said, but national surveys show that 90 percent don`t and 60 percent have never been tested.
The cost of treating millions of Americans will be considerable-$6 to $15 for each cholesterol test, $35 to $50 for complete blood analysis, plus office visits-but is greatly outweighed by the estimated $60 billion a year that is the total cost of heart disease, experts said.
The recommendations will have a major impact on the practice of medicine, said Loftus, who represented Ohio at an American Heart Association conference in Washington in early October where the program was announced.
``Now we are emphasizing what the patient can do for himself to prevent disease. This is a shift toward using diet and behavior modification, instead of relying on drugs and technology,`` Loftus said.
Dr. John P. Campbell, director of endocrinology at Akron, Ohio, General Medical Center, said the goal is to detect high cholesterol early in life.
``If we can find the problem at the age of 20 or 30 and get patients to change their eating and exercise habits, we may be able to prevent a catastrophic heart attack or stroke in mid-life,`` Campbell said.
Another major change is that doctors should not initiate diet or drug therapy without doing a follow-up test, lipid analysis, to find out the levels of LDL (low-density lipoprotein), the harmful type of cholesterol.-