National Cholesterol Education Program

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Presentation transcript:

National Cholesterol Education Program Adult Treatment Panel III (ATP III Guidelines)

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 <7% of total calories - Dietary cholesterol <200 mg calories LDL-lowering therapeutic options - Plant stanols/sterols (2 g per day) - Viscous (soluble) fiber (10-25 g per day) Weight Reduction Increased Physical Activity

National Cholesterol Education Reports Adult Treatment Panel I (1988) Recommendations for Improving Cholesterol Measurement (1990) Recommendations on Lipoprotein Measurement (1995) Population Strategies for Blood Cholesterol Reduction (1990) Blood Cholesterol Levels in Children and Adolescents (1991) Adult Treatment Panel II (1993) Adult Treatment Panel III (2001)

Focus on Multiple Risk Factors New Features of ATP III Focus on Multiple Risk Factors Diabetes: CHD risk equivalent Framingham projections of 10-year CHD risk - Identify certain patients with multiple risk factors for more intensive treatment Multiple metabolic risk factors (metabolic syndrome) - Intensified therapeutic lifestyle changes

Modification of Lipid and Lipoprotein Classification New Features of ATP III Modification of Lipid and Lipoprotein Classification LDL cholesterol <100 mg/dL—optimal HDL cholesterol <40 mg/dL - Categorical risk factor - Raised from <35 mg/dL Lower triglyceride classification cut points - More attention to moderate elevations

New Recommendation for Screening/Detection New Features of ATP III New Recommendation for Screening/Detection Complete lipoprotein profile preferred - Fasting total cholesterol, LDL, HDL, triglycerides Secondary option - Non-fasting total cholesterol and HDL - Proceed to lipoprotein profile if TC 200 mg/dL or HDL <40 mg/dL

New Features of ATP III More Intensive Lifestyle Intervention (Therapeutic Lifestyle Changes = TLC) Therapeutic diet lowers saturated fat and cholesterol intakes to levels of previous Step II Adds dietary options to enhance LDL lowering - Plant stanols/sterols (2 g/d) - Viscous (soluble) fiber (10–25 g/d) Increased emphasis on weight management and physical activity

New strategies for Promoting Adherence New Features of ATP III New strategies for Promoting Adherence In both: Therapeutic Lifestyle Changes (TLC) Drug therapies

New Features of ATP III For patients with triglycerides  200 mg/dL - LDL cholesterol: primary target of therapy - Non-HDL cholesterol: secondary target of therapy Non HDL-C = total cholesterol – HDL cholesterol

Cost Effectiveness Issues Therapeutic lifestyle changes (TLC) - Most cost-effective therapy Drug therapy - Dominant factor affecting costs - Cost effectiveness: one factor in the decision for drug therapy - Declining price of drugs: increases cost effectiveness