"We should be promoting physical activity at all levels of risk," said lead researcher Peter T. Katzmarzyk, an associate professor in the School of Physical and Health Education at Queens University, in Kingston, Ontario.

The main objective of the study was to assess changes to guidelines from the National Cholesterol Education Program Adult Treatment Panel III (ATP). The guidelines are aimed at lowering LDL "bad" cholesterol and predicting risk for cardiovascular disease.

In their study, Katzmarzyk's team collected data on more than 19,000 men, aged 20 to 79 years old, who attended a preventive medical clinic between 1979 and 1995.

During more than 10 years of follow-up, 179 of the men in the study died from cardiovascular disease. Compared with men who met the acceptable LDL levels, men who required changes in diet and exercise were at twice the risk of cardiovascular death, while men who needed aggressive cholesterol-lowering drug therapy were at almost seven times the risk, the researchers report.

In addition, the researchers found that one-third of the men in the highest cholesterol group also had signs of metabolic syndrome. Metabolic syndrome means having three or more of the following cardiovascular risk factors: abdominal obesity, high levels of blood fats called triglycerides, low HDL cholesterol, high blood pressure or high blood glucose. Metabolic syndrome, even without high LDL cholesterol, doubles the risk of death from cardiovascular disease.

According to Katzmarzyk, 25 percent of Americans aged 20 to 79 need aggressive lipid-lowering therapy. "These new guidelines will definitely save lives if they are implemented," he said.

An exciting finding was that men who were physically active had a significantly reduced risk of dying from cardiovascular disease regardless of their cholesterol level. "Men who were physically active had a 50 percent reduction in risk," Katzmarzyk said.

The reason physical fitness reduces cardiovascular risk is that all of the risk factors that makeup metabolic syndrome are sensitive to exercise, said study co-author Dr. Timothy S. Church, medical director at The Cooper Institute, in Dallas.

"It shouldn't be called metabolic syndrome," Church said. "It should be called physical inactivity syndrome."