Research Article| Volume 96, ISSUE 4, SUPPLEMENT , 53-59, August 22, 2005

Download started.


Recent National Cholesterol Education Program Adult Treatment Panel III Update: Adjustments and Options

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
        Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).
        Circulation. 2002; 106: 3143-3421
      1. National Cholesterol Education Program.
        ATP III Guidelines At-a-Glance Quick Desk Reference. US Dept of Health and Human Services, Public Health Service, Bethesda, MD2001 (NIH Publication No. 01-3305. Available at: Accessed January 1, 2005.)
        • American Diabetes Association
        Standards of medical care in diabetes.
        Diabetes Care. 2005; 28: S4-S36
        • Collins R.
        • Armitage J.
        • Parish S.
        • Sleight P.
        • Peto R.
        MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals.
        Lancet. 2002; 360: 7-22
        • Shepherd J.
        • Blauw G.J.
        • Murphy M.B.
        • Bollen E.L.
        • Buckley B.M.
        • Cobbe S.M.
        • Ford I.
        • Gaw A.
        • Hyland M.
        • Jukema J.W.
        • et al.
        • Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) study group
        Pravastatin in elderly individuals at risk of vascular disease (PROSPER).
        Lancet. 2002; 360: 1623-1630
        • ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group
        Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care.
        JAMA. 2002; 288: 2998-3007
        • Sever P.S.
        • Dalhof B.
        • Poulter N.R.
        • Wedel H.
        • Beevers G.
        • Caulfield M.
        • Collins R.
        • Kjeldsen S.
        • Kristinsson A.
        • McInnes G.
        • et al.
        Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA).
        Lancet. 2003; 361: 1149-1158
        • Cannon C.P.
        • Braunwald E.
        • McCabe C.H.
        • Rader D.J.
        • Rouleau J.L.
        • Belder R.
        • Joyal S.V.
        • Hill K.A.
        • Pfeffer M.A.
        • Skene A.M.
        • Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators
        Comparison of intensive and moderate lipid lowering with statins after acute coronary syndromes.
        N Engl J Med. 2004; 350: 1495-1504
        • Grundy S.M.
        • Cleeman J.I.
        • Merz C.N.
        • Brewer Jr, H.B.
        • Clark L.T.
        • Hunninghake D.B.
        • Pasternak R.C.
        • Smith Jr, S.C.
        • Stone N.J.
        Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.
        Circulation. 2004; 110: 227-239
        • McNamara J.R.
        • Cole T.G.
        • Contois J.H.
        • Ferguson C.A.
        • Ordovas J.M.
        • Schaefer E.J.
        Immunoseparation method for measuring low density lipoprotein cholesterol directly from serum evaluated.
        Clin Chem. 1995; 41: 232-240
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of the low density lipoprotein cholesterol in plasma without the use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Colhoun H.M.
        • Betteridge J.
        • Durrington P.N.
        • Hitman G.A.
        • Neil A.W.
        • Livingstone S.J.
        • Thomason M.J.
        • Mackness M.I.
        • Charlton-Menys V.
        • Fuller J.H.
        • CARDS Investigators
        Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS).
        Lancet. 2004; 364: 685-696
        • Kannel W.B.
        • Wilson P.W.
        Risk factors that attenuate the female coronary disease advantage.
        Arch Intern Med. 1995; 155: 57-61
        • Eimer M.J.
        • Stone N.J.
        Evidence-based treatment of lipids in the elderly.
        Curr Atheroscler Rep. 2004; 6: 388-397
        • Rubins H.B.
        • Robins S.J.
        • Collins D.
        • Fye C.L.
        • Anderson J.W.
        • Elam M.B.
        • Faas F.H.
        • Linares E.
        • Schaefer E.J.
        • Schectman G.
        • et al.
        • Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group
        Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol.
        N Engl J Med. 1999; 341: 410-418
        • Robins S.J.
        • Rubins H.B.
        • Faas F.H.
        • Schaefer E.J.
        • Elam M.B.
        • Anderson J.W.
        • Collins D.
        • Veterans Affairs HDL Intervention Trial (VA-HIT)
        Insulin resistance and cardiovascular events with low HDL cholesterol.
        Diabetes Care. 2003; 26: 1513-1517
        • Brown B.G.
        • Zhao X.Q.
        • Chait A.
        • Fisher L.D.
        • Cheung M.C.
        • Morse J.S.
        • Dowdy A.A.
        • Marino E.K.
        • Bolson E.L.
        • Alaupovic P.
        • et al.
        Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.
        N Engl J Med. 2001; 345: 1583-1592