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Perspectives and Guidelines: 

Perspectives and Guidelines National Heart, Lung, and Blood Institute National Cholesterol Education Program

National Cholesterol Education Program Coordinating Committee: 

National Cholesterol Education Program Coordinating Committee Agency for Healthcare Research and Quality American Academy of Family Physicians American Academy of Insurance Medicine American Academy of Pediatrics American Association of Occupational Health Nurses American Association of Office Nurses American College of Cardiology American College of Chest Physicians American College of Nutrition American College of Obstetricians and Gynecologists American College of Occupational and Environmental Medicine American College of Preventive Medicine American Diabetes Association, Inc. American Dietetic Association American Heart Association American Hospital Association American Medical Association American Nurses Association American Osteopathic Association American Pharmaceutical Association American Public Health Association American Red Cross Association of Black Cardiologists Association of State and Territorial Health Officials Centers for Disease Control and Prevention Citizens for Public Action on Blood Pressure and Cholesterol, Inc. Coordinating Committee for the Community Demonstration Studies Health Resources and Services Administration National Black Nurses Association, Inc. National Cancer Institute National Center for Health Statistics National Heart, Lung, and Blood Institute National Medical Association NHLBI Ad Hoc Committee on Minority Populations Office of Disease Prevention and Health Promotion Society for Nutrition Education Society for Public Health Education U.S. Department of Agriculture U.S. Department of Defense U.S. Department of Veterans Affairs (VA) U.S. Food and Drug Administration

CHD Outcomes in Clinical Trials of LDL Cholesterol-Lowering Therapy: 

Mean CHD CHD No. No. Person- cholesterol Incidence Mortality Intervention trials treated years reduction (%) (% change) (% change) Surgery 1 421 4,084 22 -43 -30 Sequestrants 3 1,992 14,491 9 -21 -32 Diet 6 1,200 6,356 11 -24 -21 Statins 12 17,405 89,123 20 -30 -29 Source: This table is adapted from the meta-analysis of Gordon, 2000. CHD Outcomes in Clinical Trials of LDL Cholesterol-Lowering Therapy

Risk Assessment: 

Risk Assessment Count major risk factors For patients with multiple (2+) risk factors Perform 10-year risk assessment For patients with 0–1 risk factor 10 year risk assessment not required Most patients have 10-year risk andlt;10%

Major Risk Factors (Exclusive of LDL Cholesterol) That Modify LDL Goals: 

Major Risk Factors (Exclusive of LDL Cholesterol) That Modify LDL Goals Cigarette smoking Hypertension (BP 140/90 mmHg or on antihypertensive medication) Low HDL cholesterol (andlt;40 mg/dL)† Family history of premature CHD CHD in male first degree relative andlt;55 years CHD in female first degree relative andlt;65 years Age (men 45 years; women 55 years) † HDL cholesterol 60 mg/dL counts as a 'negative' risk factor; its presence removes one risk factor from the total count.

Diabetes: 

Diabetes In ATP III, diabetes is regarded as a CHD risk equivalent.

CHD Risk Equivalents: 

CHD Risk Equivalents Risk for major coronary events equal to that in established CHD 10-year risk for hard CHD andgt;20% Hard CHD = myocardial infarction + coronary death

Diabetes as a CHD Risk Equivalent: 

Diabetes as a CHD Risk Equivalent 10-year risk for CHD  20% High mortality with established CHD High mortality with acute MI High mortality post acute MI

CHD Risk Equivalents: 

CHD Risk Equivalents Other clinical forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and carotid artery disease [symptomatic or andgt;50% stenosis]) Diabetes Multiple risk factors that confer a 10-year risk for CHD andgt;20%

Three Categories of Risk that Modify LDL-Cholesterol Goals: 

Risk Category CHD and CHD risk equivalents Multiple (2+) risk factors Zero to one risk factor LDL Goal (mg/dL) andlt;100 andlt;130 andlt;160 Three Categories of Risk that Modify LDL-Cholesterol Goals

LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC)and Drug Therapy in Different Risk Categories: 

LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories

LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC)and Drug Therapy in Different Risk Categories: 

LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories

Therapeutic Lifestyle Changes in LDL-Lowering Therapy: 

Therapeutic Lifestyle Changes in LDL-Lowering Therapy Major Features TLC Diet Reduced intake of cholesterol-raising nutrients (same as previous Step II Diet) Saturated fats andlt;7% of total calories Dietary cholesterol andlt;200 mg per day LDL-lowering therapeutic options Plant stanols/sterols (2 g per day) Viscous (soluble) fiber (10–25 g per day) Weight reduction Increased physical activity

Benefit Beyond LDL Lowering: The Metabolic Syndrome as a Secondary Target of Therapy: 

Benefit Beyond LDL Lowering: The Metabolic Syndrome as a Secondary Target of Therapy General Features of the Metabolic Syndrome Abdominal obesity Atherogenic dyslipidemia Elevated triglycerides Small LDL particles Low HDL cholesterol Raised blood pressure Insulin resistance ( glucose intolerance) Prothrombotic state Proinflammatory state

Diagnosis of the Metabolic Syndrome: 

Diagnosis of the Metabolic Syndrome Any 3 of the following: Waist circumference andgt;40 inches (men), andgt;35 inches (women) Triglycerides 150 mg/dL HDL andlt;40 mg/dL (men), andlt;50 mg/dL (women) BP 130/85 mm Hg Fasting glucose andgt;100 mg/dL

Metabolic Syndrome (continued): 

Metabolic Syndrome (continued) Therapeutic Objectives To reduce underlying causes Overweight and obesity Physical inactivity To treat associated lipid and non-lipid risk factors Hypertension Prothrombotic state Atherogenic dyslipidemia (lipid triad)

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