National Cholesterol Education Month

10 Great Ideas for Promoting
National Cholesterol Education Month 2007

Here are some great ideas that you can adapt and apply to fit the needs of your program.

How do your cholesterol numbers measure up? Your numbers are crucial for knowing your chance of having a heart attack. In September, National Cholesterol Education Month, have your cholesterol checked. Then, find out your risk for heart disease—and how to lower it.

1. Know your cholesterol numbers. A fasting lipoprotein profile measures total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride levels. Everyone age 20 or older should have this blood test at least once every 5 years.
   
   
2. Know your risk for coronary heart disease (CHD). How likely are you to develop heart disease or have a heart attack? People with CHD or diabetes are at the greatest risk for a heart attack. Others can look at their LDL ("bad") cholesterol level and other risk factors for CHD to evaluate their CHD risk. Cholesterol-lowering treatment primarily aims to lower the level of LDL, the main source of blockage in the arteries. The higher the CHD risk, the lower the LDL treatment goal (see table). The factors (other than LDL) that affect this goal are: cigarette smoking, high blood pressure, low HDL ("good") cholesterol, family history of early heart disease, and older age.
   
   If you have two or more of the above risk factors (other than a high LDL), estimating your risk for having a heart attack in the next 10 years is recommended, according to the latest national guide-lines. A risk score over 20 percent is considered as high a risk as having CHD ("CHD equivalent"). Find out your risk score with an online calculator from the National Cholesterol Education Program (NCEP), a public health initiative of the National Heart, Lung, and Blood Institute (NHLBI). Go to the NHLBI ATP III Web page (www.nhlbi.nih.gov/guidelines/cholesterol) and look under Information for Patients.
   
   
3. Reach your goal. Many people can reach their LDL goal through therapeutic lifestyle changes, such as improving their diet, physical activity level, and weight management. Some, however, will also need medication.

In addition, people with metabolic syndrome—a cluster of risk factors such as obesity, high triglyceride levels, and a low HDL level—may need additional treatment after reaching their LDL treatment goal.

For more information, visit the NCEP Web page (www.nhlbi.nih.gov/chd).

LDL Cholesterol Goals Based on Risk Categories

* other than LDL

Online Kit Contents. . .

There are many exciting types of information in NCEP KIT 2007 for use by the public and health professionals alike. Each piece is different, so be sure to take the time to explore each one.

• Your Guide to Lowering Cholesterol with TLC
• 10 Great Ideas
• Chart Your Progress, Reach Your Goal Worksheet
• ATP III Update Paper
• Q's & A's on the New Food Label
• Simple Steps to Help Reduce Your Risk
• Cholesterol Month Pledge
• Heart Healthy Recipes
• Resource List
• Additional Cholesterol Information for Patients and the General Public
• Additional Cholesterol Information for Health Care Professionals

I/We the undersigned, in celebration of National Cholesterol Education Month 2007, pledge to do at least three of the following to help lower my/our cholesterol and reduce my/our risk for heart disease:

	To know my/our cholesterol numbers, including total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
	To find out what my/our 10-year risk for heart disease is and to find out what my/our LDL cholesterol goal should be.
	To read food labels at the grocery store and to purchase primarily foods that are low in saturated fat, trans fat, and cholesterol.
	To pay more attention to hidden saturated fat, trans fat, and cholesterol in baked goods and foods eaten on the run.
	To learn what my/our body mass index is and to lose weight, if overweight, and to take measures to maintain a healthy weight.
	To participate in physical activity of moderate intensity — like brisk walking — for at least 30 minutes on most or all days of the week. On days when I/we don’t have time, I/we will do the activity in three, 10-minute segments during the day.
	To remain tobacco-free or, if I/we smoke, pick a quit date and ask my/our healthcare provider for help with quitting.

Drop-in article
National Cholesterol Education Month
September 2003

September is National Cholesterol Education Month

National Cholesterol Education Month 2003 continues the theme, "Know your cholesterol numbers, know your risk." This theme echoes two of the main thrusts of the latest cholesterol guidelines entitled, "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults" (Adult Treatment Panel III, or ATP III). These guidelines provide the most up-to-date recommendations on clinical cholesterol management for health care professionals. September, National Cholesterol Education Month, is a particularly good time to motivate individuals to get their cholesterol checked, know their numbers, and know their risk of developing coronary heart disease (CHD).

Latest NCEP Guidelines: ATP III

ATP III, the first major update in cholesterol management from the NCEP in nearly a decade, follows the principles of previous panel reports. Important concepts from the previous cholesterol guidelines report, ATP II, such as aggressively treating elevated low density lipoprotein (LDL) cholesterol in persons with CHD, remain in place. ATP III is evidence-based and contains a number of new features. Some of the key changes in the ATP III guidelines include:

• More aggressive cholesterol-lowering treatment and better identification of those at high risk for a heart attack.
• Use of a complete lipoprotein profile as the first test for high cholesterol.
• A new level at which low HDL (high density lipoprotein) cholesterol becomes a major heart disease risk factor.
• A new, more powerful set of therapeutic lifestyle changes (TLC) to improve cholesterol levels.
• A sharper focus on a cluster of heart disease risk factors known as the "metabolic syndrome."
• Increased attention to the treatment of high triglycerides.

As in previous ATP reports, LDL cholesterol continues to be the primary target of therapy. Recent clinical trials affirm that lowering LDL cholesterol reduces the short-term risk for heart disease by as much as 40 percent, and the long-term reduction in risk may be even greater.

Risk Assessment in ATP III

ATP III espouses the principle that the intensity of cholesterol-lowering treatment should be matched to the person's level of risk for CHD. Risk assessment in ATP III involves several straightforward steps. First, a complete lipoprotein profile (total cholesterol, LDL, HDL, and triglycerides) is obtained after a 9- to 12-hour fast. Second, the presence of clinical atherosclerotic disease (clinical CHD, carotid artery disease, peripheral arterial disease, abdominal aortic aneurysm) is identified. Clinical atherosclerotic disease is considered a CHD risk equivalent, meaning that it confers the same high risk for CHD events as in those who already have CHD. Third, the presence of major risk factors other than LDL is determined. The major risk factors exclusive of LDL are listed below:

• Cigarette smoking (any in the last month).
• Hypertension (BP 140/90 mmHg or on antihypertensive medication).
• Low HDL (<40 mg/dL).
• Family history of premature CHD (CHD in male first degree relative <55 years; CHD in female first degree relative <65 years).
• Age (men 45 years; women 55 years).

Note: In ATP III, diabetes is considered a CHD risk equivalent because persons with diabetes have virtually as high a risk of having a heart attack as someone who already has CHD.

Finally, if two or more risk factors (other than LDL) are present without CHD or CHD risk equivalent, Framingham risk scoring is used to estimate short-term (10-year) risk. Framingham risk scoring uses age, total cholesterol level, smoking status, HDL level, and systolic blood pressure to estimate 10-year risk for heart disease. ATP III divides those with multiple risk factors into three categories based on their 10-year risk for CHD: >20%, 10-20%, and <10%. The LDL goal of therapy is based on which of three categories of CHD risk the individual falls into:

• Persons with CHD or other clinical atherosclerotic disease, diabetes, or a 10-year risk >20% are placed in the highest risk group. The LDL goal for this highest risk group is <100 mg/dL.
• Persons with two or more major risk factors and a 10-year risk 20% have an LDL goal of <130 mg/dL.
• Individuals who have 0-1 major risk factor usually have a 10-year risk of <10%. The LDL goal for persons with 0-1 risk factor is <160 mg/dL.

Cholesterol-Lowering Therapy: Therapeutic Lifestyle Changes

ATP III recommends a multifaceted lifestyle approach to reducing cholesterol. This approach is termed therapeutic lifestyle changes (TLC) and includes the TLC diet, weight management, and physical activity. TLC is for anyone whose LDL is above their goal level. The TLC diet is a low saturated fat, low cholesterol eating plan that calls for less than 7% of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and to avoid weight gain. Increased amounts of viscous (soluble) fiber as well as food products containing plant stanols/sterols (such as cholesterol-lowering margarines) can also be added to the TLC diet to boost its LDL-lowering power. The other TLC components are weight management (especially for those who are overweight or obese) and increased physical activity. For additional information on TLC, visit the interactive "Live Healthier, Live Longer" Web page (www.nhlbi.nih.gov/chd/).

Cholesterol-Lowering Drug Therapy

While TLC alone may lower the LDL to goal in many persons, others (especially those with multiple risk factors and those with CHD or a CHD risk equivalent) may need a combination of TLC and drug therapy to lower their LDL cholesterol to goal. The choice of drug or drugs used will depend on the individual's lipid profile. The statins are a frequently prescribed group of drugs that effectively lower LDL cholesterol and are safe for most users. In clinical trials, LDL cholesterol lowering with statins has been shown to decrease the rate of heart attacks and deaths from CHD by approximately 30%. Statins have been shown to be effective in persons with or without CHD. To assist professionals in understanding the current recommendations for use and monitoring of statins, a clinical advisory on statins has been developed. Bile acid sequestrants also lower LDL cholesterol and can be used alone or in combination with statin drugs. Nicotinic acid (or niacin) lowers LDL cholesterol and triglycerides and raises HDL cholesterol. Nicotinic acid in doses large enough to lower cholesterol can cause side effects and should only be used under the supervision of a physician. Fibric acids are used mainly to treat high triglycerides and low HDL. Regardless of the type of drug therapy used, individuals should take an active part in their health care. In order to maximize cholesterol lowering, TLC should always be maintained when drug therapy is prescribed.

The Metabolic Syndrome

The metabolic syndrome, which affects about one-quarter of all adults in the U.S., has emerged as just as strong a contributor to early heart disease as cigarette smoking. The metabolic syndrome, also known as syndrome X or insulin resistance syndrome, is a constellation of metabolic risk factors that significantly increases the risk for coronary events. The metabolic syndrome is identified by the presence of three or more of the following: abdominal obesity (waist circumference >40 inches in men or >35 inches in women); triglycerides 150 mg/dL; HDL cholesterol <40 mg/dL in men or <50 mg/dL in women; blood pressure 130/85 mmHg; and fasting glucose 110 mg/dL. First-line therapy for the metabolic syndrome is TLC, especially weight loss and physical activity, to address the underlying causes of overweight/obesity and physical inactivity. Additional information on the metabolic syndrome can be found in the "ATP III Executive Summary" and in the "ATP III Guidelines At-A-Glance Quick Desk Reference" on the NHLBI ATP III Web page (www.nhlbi.nih.gov/guidelines/cholesterol/).

ATP III Implementation Tools

To help ensure implementation of the ATP III guidelines, the NCEP has developed an array of products and tools to accelerate their adoption into practice. For professionals, these aids include an executive summary that synopsizes the evidence and recommendations; a PowerPoint^® slide show for teaching the guidelines to professional audiences; an ATP III At-A-Glance Desk Reference that outlines basic action steps; an interactive tool for Palm OS devices that is designed for use at the point of care; a 10-year CHD risk calculator available in online and downloadable (Excel spreadsheet) versions; and a clinical advisory on statins. To empower patients to be active partners in their care, NCEP has developed a new patient booklet entitled "High Blood Cholesterol—What You Need to Know;" a 10-year CHD risk calculator for lay audiences; and an updated Web page "Live Healthier, Live Longer" that reflects the new information in ATP III. All of these tools are available on the ATP III Web page (www.nhlbi.nih.gov/guidelines/cholesterol/). Several of the ATP III products are also available in hard copy at the NHLBI Health Information Network Online Catalog (http://emall.nhlbihin.net).

NCEP Jumpstarts Implementation of Latest Guidelines

To promote the adoption of the ATP III guidelines, the National Heart, Lung, and Blood Institute (NHLBI) and the National Committee for Quality Assurance (NCQA) jointly sponsored a national conference, "Advances in Cholesterol Management: Putting the New National Cholesterol Education Program Guidelines into Practice." Portions of the conference were Webcast and may be viewed online at the ATP III Web page.

To Order Cholesterol Education Materials
(Online Catalog)

General Public/Patients

• Eating With Your Heart in Mind (7-10 Year Olds)
• Hearty Habits: Don't Eat Your Heart Out (15-18 year olds)

Health Professionals

• Executive Summaries of Recommendations on Lipoprotein Measurement
• Highlights of the NCEP Report on Blood Cholesterol Levels in Children and Adolescents
• NCEP Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents
• Recommendations on Lipoprotein Measurement

CHD Web site home pageVisit the National Cholesterol Education Program interactive page, "Live Healthier, Live Longer" to find:

• Information for those who want to prevent heart disease
• Information for those with heart disease who want to reduce their risk of having a heart attack
• A "how to" step-by-step guide to lowering cholesterol
• Heart healthy recipes
• Engaging activities such as Create-a-Diet
• A resource library, virtual fitness center, and cyber café
• Tip sheets on heart healthy life habits
• Quizzes on cholesterol and heart disease
• How to read food labels
• Frequently asked questions
• And much more!

Dear Colleague:

Thank you for your interest in and support for National Cholesterol Education Month. Cholesterol Month 2003 continues the theme, "Know your cholesterol numbers, know your risk." This theme highlights two of the main thrusts of the latest cholesterol guidelines, clearly emphasizing the importance of having your cholesterol measured and knowing your risk of developing heart disease. This year's Cholesterol Month kit contains a variety of materials and tools that will assist you in bringing the latest information on cholesterol lowering into your community, program, or practice.

Cholesterol Month is an especially good time to recharge your cholesterol education activities. Build your activities on the latest National Cholesterol Education Program (NCEP) guidelines for cholesterol management: the "Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults" (Adult Treatment Panel III, or ATP III).

ATP III, which was developed by an expert panel of 27 members and extensively reviewed by the members of the NCEP Coordinating Committee representing 40 leading health and medical organizations, as well as by 19 additional cholesterol authorities, is evidence-based and heavily referenced. ATP III maintains many core principles of ATP II, including a focus on LDL cholesterol as the primary target of therapy, and the need for intensive cholesterol treatment in patients with coronary heart disease (CHD). Naturally, ATP III also has a number of new features, including: more aggressive cholesterol-lowering treatment and better identification of those at high risk for a heart attack; use of a complete lipoprotein profile as the first test for high cholesterol; a new level at which low HDL cholesterol 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.

To assist in the implementation of the ATP III guidelines, several new tools have been developed. For professionals, a risk assessment tool for calculating the risk for having a heart attack in the next 10 years, an interactive guideline tool for Palm OS^® devices, an ATP III At-A-Glance Quick Desk Reference, and a clinical advisory on statins are available at the NHLBI ATP III Web page (www.nhlbi.nih.gov/guidelines/cholesterol/). Patients also can assess their risk by using an online risk calculator, or by using the Framingham risk scoring tables in the brochure, "High Blood Cholesterol—What You Need To Know," also available at the NHLBI ATP III Web page (www.nhlbi.nih.gov/guidelines/cholesterol/). The interactive Web page "Live Healthier, Live Longer" (www.nhlbi.nih.gov/chd/) has been updated to reflect the ATP III guidelines. It provides detailed information on lowering cholesterol for those who want to prevent CHD, as well as those who already have CHD and want to reduce their risk for a heart attack.

Your 2003 Cholesterol Month community kit includes the essential tools and materials to broadcast this year's theme, "Know your cholesterol numbers, know your risk." Some of the helpful items contained in your kit include:

• A drop-in article that discusses the major areas of focus for Cholesterol Month 2003: new features of ATP III; risk assessment in ATP III; ways to lower cholesterol; and a review of the tools developed to facilitate implementation of ATP III.
• Ten great ideas for Cholesterol Month activities in settings such as the workplace, the physician's office, the community, and the grocery store.
• Q's & A's on the new food label: saturated fat, trans fat, and cholesterol.
• Heart healthy recipes to distribute at health fairs or classes.
• Hot links to cholesterol education Web sites, including the revised "Live Healthier, Live Longer" Web page.

These are just a few of the materials in your Cholesterol Month kit. Be sure to check out each piece offered. Thank you for using the 2003 Cholesterol Month kit in supporting National Cholesterol Education Month through your organization's activities in September and throughout the year.

Sincerely,

James I. Cleeman, M.D.
Coordinator
National Cholesterol Education Program

Questions and Answers About the New Food Label:
Saturated Fat, Trans Fat, and Cholesterol

To access any of the cookbooks, simply click on the cookbook title. From there, you will be connected directly to the Web page where you can download the entire cookbook or selected recipes.

Heart-Healthy Home Cooking: African American Style

Nothing beats home-style cooking. The Heart-Healthy Home Cooking Cookbook contains over 20 recipes that will help you prepare home-style meals the healthy way, low in saturated fat, cholesterol, and calories. All recipes can be prepared using simple, everyday ingredients. These recipes may be low in saturated fat and cholesterol, but they certainly are not low in taste. Recipes in the booklet include southern barbecued chicken, savory potato salad, classic macaroni and cheese, and sweet potato pie. NIH Publication No. 97-3792.

Delicious Heart Healthy Latino Recipes

These recipes can help you prepare your favorite, traditional Latino dishes in a heart healthy way. This bilingual cookbook contains 23 tested recipes that cut down on fat, cholesterol, and sodium but not on taste. Who knew that by substituting a few key ingredients, traditional Latino dishes can be transformed into heart-healthy meals the entire family can enjoy? NIH Publication No. 96-4049.

Stay Young at Heart Recipe Cards

Carrot-raisin bread? Barbecue chicken? Baked pork chops? Heart healthy pumpkin pie? Sound too good to be true? The 12 recipes in this packet will convince you that healthy dishes can also be delicious. Each recipe also lists total fat, saturated fat, cholesterol, sodium, and calories per serving.

National Cholesterol Education Month
Resource List

You can contact the following associations, Government agencies, and clearinghouses for additional information and materials about cholesterol and cholesterol lowering.

(Please note: Some of the following links go outside the NHLBI Web site; to return to this document, close the new window.)

National Heart, Lung, and Blood Institute





www.nhlbi.nih.gov

Agency for Healthcare Research and Quality
Publication Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
Phone: (800) 358-9295
Fax: (410) 290-3841
ahrq.pubs@ahrq.gov
www.ahrq.gov

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: (800) 342-2383
customerservice@diabetes.org
www.diabetes.org

American Dietetic Association
216 West Jackson Boulevard, Suite 800
Chicago, IL 60606-6995
Phone: (800) 366-1655 (Consumer Nutrition Hotline)
Toll-free: (800) 745-0775 (Publications Service)
info@eatright.org
www.eatright.org

American Heart Association
National Center
7272 Greenville Avenue
Dallas, TX 75231
Toll-free: (800) AHA-USA1
inquiries@heart.org
www.americanheart.org

Food and Drug Administration
Office of Consumer Affairs
5600 Fishers Lane, HFE-88
Rockville, MD 20857
Phone: (888) 463-6332
Toll-free: (888) INFO-FDA
Fax: (301) 443-9057
www.fda.gov

National Women's Health Information Center
Phone: (800) 994-9662
Toll-free: (888) 220-5446
Fax: (301) 443-9057
www.4woman.gov

Health-related Internet sites with cholesterol information:

• National Heart, Lung, and Blood Institute Web Site
• Healthfinder
• Medline Plus
  

Local sources of cholesterol information and materials:

Good local sources include: state and county or city health departments; area hospitals and managed care organizations; local chapters of professional organizations representing physicians, nurses, dietitians, pharmacists, and other health professionals; libraries; grocery stores; and universities, to name just a few.

Chart Your Progress - Reach Your Goal

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