Rationale for Lowering the Upper Normal Limit of Total Cholesterol Levels to 180 mg/dl Among Turks

S ince the coronary risk profile of Turkish adults was found to differ significantly from Western populations and international guidel ines on prevention are considered to have shortcomings for Turks, a new approach was sought. W ith the purpose of comprising into a prevention program those individuals at high risk who have thus far not been included in primary and secondary coronary prevention, the thesis is proposed (based on the database of the Turkish Adult Risk Factor Study) that the upper limit of nomıal total cholesterol (TC) levels be reduced to 180 ıng/di. Of the estiınated 5 million adults harboring levels of TC 180-200 ıng/di , about 800,000 are considered to be at high coronary risk. Subjects at high risk were defined by a TC/HDLcholesterol ratio >5 in men aged (50 or women aged (60 years. Even in primary prevention in this group, the benefit of drug therapy should not be withheld, in addition to lifesryle changes, with the aiın of improving the dyslipidemia involving plasma triglycerides and HDL-cholesterol. The hypothesis was suppoıted not only by mathematical and ınetabolic evidences, but also by the British recommendations and the Framinghaın risk function as well as the findings of the Turkish Adult Risk Factor Study. If these criterla are incorporated into the forthcoming g uidelines of the Turkish Society of Cardiology and are iınplemented, a significant proportion of the estimated 45-50,000 new coronary events each year occurring in persons with TC levels of 180-200 mg/d! ınay be prevented.