Published: 08/01/2004, Volume II4, No. 5886 Page 24

Obesity is given serious media attention, and rightly so. But there is another element in the diet and health debate that is not: raised blood cholesterol.

This is a factor in almost half of the 125,000 coronary heart disease deaths each year, occurring with greater frequency in the population than smoking or high blood pressure. Raised blood cholesterol is also a major factor in the 130,000 strokes suffered each year.

It is little wonder that the national service framework for CHD has driven statin prescribing. But surprisingly, little attention has been given to lowering raised blood cholesterol levels in the wider population - especially as 70 per cent of the adult UK population is estimated to have blood cholesterol above recommended healthy levels. The effectiveness of statins in lowering blood cholesterol and reducing CHD risk is well known, but diet and lifestyle changes must be recognised as an independent strand of public health, as well as a precursor and partner to drug therapy.

The modifiable nature of raised blood cholesterol means that cholesterol levels can be reduced and managed through diet and lifestyle changes. US guidelines recommend a multifaceted lifestyle approach to cholesterollowering public health strategies, incorporating healthy-heart diet, increased physical activity and appropriate weight loss.

In the UK and abroad, most famously in Finland, cholesterolfocused health promotion has been successful. The majority of UK adults need to take action, and high cholesterol should be a focal point of self-care strategies.

The government's food and health action plan, and the forthcoming public health review by its adviser Derek Wanless, are great opportunities for positive change. Cholesterol UK hopes these will rightly conclude that dealing with blood cholesterol should have greater priority in future UK public health strategies.

Dr John Reckless Chair, HEART UK, Board member Cholesterol UK