"My opinion, based on the totality of the evidence that has come out, is that it is likely that there will be important revisions to the guidelines, but that should be determined by the individual advisory groups that will be writing them," he said.
In its update of the guidelines, the NHLBI called for more use of measures such as physical activity and weight loss to reduce the risk of heart attack and other cardiovascular problems.
Cholesterol is only one part of the heart risk picture, Fonarow said. Risk climbs higher with age, especially for men and for those with close relatives who have had cardiovascular conditions.
"The good news is that as much as 80 percent of the risk factors are under individual control and are modifiable," Fonarow said. "You can't control your family history, age or sex, but you can keep your blood pressure low, exercise and modify your lifestyle in other ways to reduce risk."
While calling the study "excellent," Dr. Manesh Patel, an assistant professor of medicine at Duke University, added, "The problem is that this is a snapshot, but we're not sure we know all the risk factors and how they interplay."
The researchers did not measure blood levels of other molecules involved in cardiovascular disease, such as the inflammation biomarker C-reactive protein and lipoprotein(a), he said.
But it's quite possible that the cholesterol guidelines will be changed, Patel said. "Ongoing studies have led to getting the LDL level to 100 and then to 70," he said. "As more randomized trials come out, there may be further changes."
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