In the summer of 2004, an evidence-based update of the National Cholesterol Education
Program (NCEP) Adult Treatment Panel III (ATP III) guidelines for management of hypercholesterolemia
was published. This detailed assessment of 5 major clinical trials, published since
the ATP III report in 2001, was designed to provide guidance for physicians in decision
making for patients at high risk and very high risk. We have tried to summarize this
assessment by suggesting the following to clinicians: (1) Calculate global risk of
coronary artery disease (CAD) to determine an overall strategy for cholesterol management.
(2) Emphasize the benefits of diet, exercise, and weight control or therapeutic lifestyle
change, especially in those with lifestyle risk factors. (3) Use 3-hydroxy-3-methyglutaryl
coenzyme A reductase inhibitors (statins) as first-line drugs to reduce risk of CAD
and stroke in those at moderate to high risk. (4) If statins are prescribed, use moderate
doses that reduce plasma levels of low-density lipoprotein (LDL) cholesterol by ≥30%
to 40%. (5) Strongly consider statin therapy in those with diabetes (with the exception
of severe hypertriglyceridemia). (6) Consider LDL cholesterol-lowering drug therapy
for lipids in older patients at risk. (7) Consider adding either a fibrate or nicotinic
acid in high-risk patients with elevated plasma triglyceride values or low levels
of plasma high-density lipoprotein cholesterol after statin therapy has achieved the
LDL cholesterol goal. (8) Continue to treat those at low risk in similar fashion as
before. This update is to inform current physician judgment in this area. Further
clinical trial data that may modify or extend these recommendations are eagerly awaited.
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Article info
Publication history
Published online: June 27, 2005
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© 2005 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
