New Cholesterol Guidelines Issued

Primary prevention of coronary heart disease in people with multiple risk factors and early, aggressive lipid-lowering therapy for those at highest risk are the key elements of new cholesterol guidelines provided in the U.S. Third Report of the National Cholesterol Education Program (NCEP). A summary of the report was published in the May 16, 2001, issue of The Journal of the American Medical Association (JAMA).

The Adult Treatment Panel III (ATP III), which updates existing recommendations, was prepared by a multi-disciplinary panel that included leading clinicians and researchers. One major new feature is a focus on primary prevention in people with multiple risk factors. To assess an individual's risk, a fasting lipoprotein profile (total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides) should be obtained once very five years, advises the panel. Other risk factors used to determine risk over the next ten years include the presence or absence of coronary heart disease (CHD), other clinical forms of atherosclerotic disease, cigarette smoking, hypertension, low HDL, age, and a family history of CHD. Patients with diabetes are also considered candidates for aggressive therapy because their absolute risk for major events is very high.

Patients with an absolute 10-year risk of 20% for developing CHD are considered candidates for aggressive therapy, with a treatment goal of LDL levels less than 100 mg/dl. Those with LDL cholesterol of 130 mg/dl or higher are recommended for drug therapy. Patients with diabetes are also considered candidates for aggressive therapy because their absolute risk for major events is very high. Recommended therapeutic lifestyle changes to reduce risk include reduced intake of saturated fats and cholesterol, weight reduction, and increased physical activity. The panel recommends that women and men be treated similarly for prevention of CHD.

The panel also suggests a series of interventions to improve adherence to the guidelines, including simplified medication regimens for patients, lipid clinics, and case management by nurses. "Thus, ATP III recommends the use of state-of-the-art multi-disciplinary methods targeting the patient, clinicians, and health delivery systems to achieve the full population effectiveness of the guidelines for primary and secondary prevention,” concludes the panel.



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