U.S. Urges Cholesterol Cut Even if Disease Risk Is Low

The federal government recommended Tuesday that all Americans adopt new eating habits to reduce their intake of cholesterol, predicting that heart disease could be reduced by 20% during the next decade as a result.

The National Cholesterol Education Program of the National Heart, Lung and Blood Institute urged limiting intake of saturated fats to less than 10% of all calories consumed and cutting consumption of all fats to 30% or less of total calories.

Building on earlier guidelines aimed at adults who already have elevated levels of cholesterol, the panel recommended that Americans consume less than 300 milligrams of cholesterol daily.

The yolk of one egg, for example, contains 213 milligrams of cholesterol. A 3-ounce serving of water-packed tuna, in contrast, contains only 23 milligrams.

Although the organization is not the first to recommend that Americans improve their eating patterns, the federal government has never before issued specific cholesterol reduction steps for Americans not necessarily at risk for coronary heart disease.

In 1987, the panel issued similar guidelines directed at those Americans considered at great risk of coronary heart disease and recommended cholesterol-lowering drugs if dietary measures failed.

The new recommendations apply to all Americans, including low-risk men, women, children over 2 years old and the elderly. Infants are not included because most medical experts believe that their diets should be substantially higher in fat until they are 2.

“This is for the entire U.S. population,” said Dr. Richard Carleton, physician-in-chief at Memorial Hospital of Rhode Island and chairman of the panel. “For those with desirable levels of cholesterol, the evidence is that bringing down the levels will not harm them--and is likely to be beneficial.”

Coronary heart disease is the leading killer of Americans. More than 6 million people have coronary heart disease in the United States, and more than 500,000 people die from coronary heart disease every year. About 1.25 million people suffer heart attacks annually.

During the last several decades, scientific research has established a link between high blood cholesterol and the risk of heart disease.

In recent months, however, a new debate has stirred over whether diet actually has an effect on blood cholesterol levels and whether cholesterol-lowering measures have been shown to improve life expectancy.

But scientists emphasized Tuesday that the relationship between high blood cholesterol and heart disease was undisputed and that there were “unequivocal benefits” to reducing high blood cholesterol levels.

“There will always be scientific disagreement on important topics and a few who disagree with the majority,” said Dr. Claude Lenfant, director of the institute. “We feel, however, that the scientific evidence is so convincing that we have a responsibility to proceed with cholesterol-lowering recommendations for the general population.”

Elevated levels of cholesterol may lead to the early development of hardening of the arteries and coronary heart disease.

The average cholesterol level for middle-aged men and women in the United States is about 215 milligrams per deciliter of blood. Medical experts believe that 200 milligrams or less is desirable. They consider 200 to 239 as “borderline high” and 240 milligrams and above as high.

Carleton said a small segment of the U.S. population has very high cholesterol levels and a higher risk of coronary heart disease.

But he noted that a much larger group, consisting of the “many millions” of Americans with cholesterol levels below 240 milligrams, experiences more than 60% of the coronary heart disease in this country.

Carleton said that for those Americans with cholesterol levels below 200 milligrams, the new dietary suggestions should reduce average blood cholesterol by at least 10% and result in about a 20% overall reduction in heart disease.

Most Americans would not need to make drastic reductions in their fat consumption to comply with the proposals. About 13% of the calories contained in an average adult’s diet come from saturated fats, considered the major contributor to higher blood cholesterol. The panel recommended reducing the figure to 10%.

Tropical oils are high in saturated fats.

An average American woman consumes about 304 milligrams of cholesterol a day, and the average man eats about 435 milligrams, the panel said.

The panel recommended that Americans use more low-fat and skim-milk products. It said they should eat egg yolks, which are high in cholesterol, “only in moderation.”

The panel also called for expanded food labeling with clear information on the amounts of saturated fats, total fats, cholesterol and calories and asked the food industry to market products that are lower in fats and cholesterol.

Further, the panel urged supermarkets, restaurants and other food outlets to voluntarily label menus and grocery shelves with information about levels of fat, calories and cholesterol.

“Very importantly, the food industry must avoid misleading labeling or advertising,” Carleton said. “Examples include the words no cholesterol on foods that are high in saturated fatty acids and presentation of health claims not supported by scientific evidence.”

The report, which was endorsed by more than two dozen health and medical organizations, including the American Heart Assn., also recommended that Americans abstain from smoking, have their blood cholesterol measured, exercise and monitor their blood pressure.