The National Cholesterol Education Program (NCEP) II guidelines state that those with two or more heart disease risk factors and low-density lipoprotein cholesterol (LDL-C) levels of 160 mg/dL or higher should receive drug therapy. But the new NCEP III guidelines, released last year, lower the LDL-C threshold levels to 130 mg/dL or higher.

When researchers at the University of Maryland in Baltimore started number-crunching to determine the impact of these new guidelines, they received a shock.

After calculating the eligibility for drug therapy using both sets of guidelines among 13,589 individuals (aged 20-79 years), they then extrapolated their findings to the US population at large. Say the researchers, an estimated 36 million people would be referred for drug therapy under the NCEP III guidelines compared with only 15 million people under NCEP II. Furthermore, the percentages of eligible people less than 45 years of age and 65 years of age and older increased by 201 per cent and 131 per cent, respectively.

Drug therapy is an aggressive way to lower cholesterol, the researchers note, especially given the fact that life-style changes are often just as effective.

Says lead researcher Dr D.O. Fedder, 'There is an absolute need for caution; these guidelines have broad implications.' Indeed, not least of all for the elderly population who may already be overprescribed a range of other medications (Circulation, 2002; 105: 152-6).