By Suzanne Rostler

NEW YORK, Jan 14 (Reuters Health) - National cholesterol guidelines that are expected to help more Americans lower their risk of heart disease will boost the number of people eligible for cholesterol-lowering medication by 140%, according to Maryland researchers.

Their analysis indicates that the guidelines could triple the number of people younger than 45 who can take medication and increase the number of older Americans eligible for the drugs by about 130%, according to the report in the January 15th issue of Circulation: Journal of the American Heart Association.

But while cholesterol-lowering drugs have been shown to be highly effective and have relatively few side effects, they have been used widely for only about a decade and therefore the long-term effects, particularly in younger patients, are not known.

What's more, the costs of the drugs coupled with a lack of a national drug prescription benefit program could force some older individuals to choose between taking the drugs and buying food, Dr. Donald O. Fedder, the report's lead author, told Reuters Health.

"We have to look at the consequences. There is a large number of people being prescribed very expensive medication and we've had a limited number of years with (the drugs)," said Fedder, from the University of Maryland in Baltimore.

The guidelines, released last year by the National Cholesterol Education Program (NCEP), a division of the National Institutes of Health, replace those set in 1993. Now, patients with LDL ("bad") cholesterol of 130 milligrams per deciliter (mg/dL) of blood in addition to two risk factors for heart disease are eligible for medication. The previous guidelines set a threshold of 160 mg/dL plus two other risk factors.

People with high cholesterol are at risk of developing heart disease, the leading cause of death in the US. About 500,000 Americans die of heart disease each year. Other risk factors include smoking, excess weight, a sedentary lifestyle and type 2 diabetes.

Fedder noted that the updated recommendations stress that a low-fat diet with exercise is still the first-line of treatment for high cholesterol. But most people will fail to make the lifestyle changes necessary to lower their risk of heart disease, he said, and many will turn to the drugs for help.

"People who are willing to participate in lifestyle changes to the degree to which it is important can cut their cholesterol in half," depending on how high cholesterol was initially, Fedder said. "It takes dedication and sticking to it and most of us don't like to stay on diets like that."

Fedder and colleagues used both the new guidelines and the older recommendations to look at theoretical treatment options for more than 13,000 people aged 20 to 79 with known heart disease risk factors. The study participants had taken part in a national health survey conducted between 1988 and 1994.

The more recent recommendations qualify 36 million Americans for drug therapy, of whom nearly one-third are younger than 56, and more than one-quarter are older than 65. About 55% of those eligible are men.

Under the old guidelines, 15 million people aged 20 to 79 were eligible for cholesterol-lowering drugs.

Among other changes, the guidelines now recommend an even lower intake of saturated fat, a higher blood level of HDL ("good") cholesterol and more rigorous testing of fatty substances in the blood.

SOURCE: Circulation 2002;105.

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