1. Lipid Profiles & NSW LCDR Jim Mucciarone NSWG-2 16 July 2008

2. Study Reviewed age, height, weight, total cholesterol, LDL, HDL and Triglycerides in 85 SEAL physicals conducted in CY 2007. Reviewed age, height, weight, total cholesterol, LDL, HDL and Triglycerides in 85 SEAL physicals conducted in CY 2007. Compared results with ATP-III standards for Cholesterol and LDL. Compared results with ATP-III standards for Cholesterol and LDL. Target for cholesterol < 200 mg/dl Target for cholesterol < 200 mg/dl Target for LDL < 130 mg/dl Target for LDL < 130 mg/dl

3. Results Avg Age: 32.83 (21-52) Avg Age: 32.83 (21-52) Avg Cholesterol: 186.6 (108-312) Avg Cholesterol: 186.6 (108-312) Avg LDL: 119.9 (70-221) Avg LDL: 119.9 (70-221) 22/85 (25.9%) Total Chol > 200 22/85 (25.9%) Total Chol > 200 23/85 (27.1%) LDL > 130 23/85 (27.1%) LDL > 130

4. Biases Age Age 5 years AD, Retirement Physicals included 5 years AD, Retirement Physicals included Medications Medications Excluded personnel known to be on meds Excluded personnel known to be on meds Fasting Fasting Assumed patients fasted appropriately Assumed patients fasted appropriately

5. Significance Increased serum cholesterol significantly associated with increased risk of death before age 50 (Klag, et al, NEJM, 1993) Increased serum cholesterol significantly associated with increased risk of death before age 50 (Klag, et al, NEJM, 1993) Men 200 have increased overall mortality Men 200 have increased overall mortality > 240 = 2.10 to 3.63 RR of CHD or CVD death > 240 = 2.10 to 3.63 RR of CHD or CVD death Men < 39 y/o with chol < 200 = 3.8 to 8.7 years of life (Stamler, et al, JAMA, 2000) Men < 39 y/o with chol < 200 = 3.8 to 8.7 years of life (Stamler, et al, JAMA, 2000) “Grow the Force” “Grow the Force”

6. Treatment Therapeutic Lifestyle Changes Therapeutic Lifestyle Changes Reduce Sat Fats/Cholesterol Reduce Sat Fats/Cholesterol Reduce Body Weight Reduce Body Weight Increase stanols/sterols and fiber Increase stanols/sterols and fiber Increase physical activity Increase physical activity Prefer to avoid statins Prefer to avoid statins Lifelong medication Lifelong medication Assoc with muscle pain Assoc with muscle pain