Volume 102, Issue s5

Both the newly revised Adult Treatment Panel (ATP III) guidelines developed by the National Cholesterol Education Program and prospective trials indicate that lowering serum low-density lipoprotein cholesterol (LDL-C) to levels of less than 100 mg/dL is beneficial to minimize the risk of coronary heart disease (CHD). However, the risk of acute coronary events is related not just to lipid levels, but also to inflammatory pathophysiologic processes that heighten the risk of plaque rupture. Statin therapy effectively lowers LDL-C to target (optimal) levels, and the newer formulas are proving to provide greater reductions. In addition, research demonstrates that statins also counteract thrombosis, reduce inflammation, improve endothelial function, block plaque formation and progression, and stimulate the growth of new blood vessels in ischemic tissues. Global risk reduction-including diet, exercise, weight loss, and drug therapy are keys to minimizing CHD events.

Reducing high levels of plasma low-density lipoprotein cholesterol (LDL-C) is still the primary focus of the Adult Treatment Panel III (ATP III) guidelines developed by the National Cholesterol Education Program. The LDL-C goal of less than 100 mg/dL for those with coronary heart disease (CHD) is now extended to patients with diabetes and those with a Framingham risk score of greater than 20% in 10 years, both of which are now considered "CHD risk equivalents." Consequently, many more people will be considered candidates for aggressive lipid-lowering therapy under the new ATP III guidelines. Other prominent features in the new guidelines include determining an individual's absolute risk category by using a nine-step process, instituting therapeutic lifestyle changes to reduce LDL-C levels, and strategies for treating patients with other forms of dyslipidemia such as metabolic syndrome.

The Adult Treatment Panel III (ATP III) guidelines continue to emphasize intensive treatment for persons at risk for coronary heart disease (CHD). The newest feature is a focus on primary prevention in persons with multiple risk factors; the updated guidelines recognize diabetes as a CHD risk equivalent. These groups of people already are at high risk and can benefit from increased intensive treatment to lower serum low-density lipoprotein cholesterol (LDL-C) levels. The ATP III guidelines establish lower targets for LDL-C and triglyceride levels and higher targets for the high-density lipoprotein cholesterol level. The guidelines also combine several risk factors to estimate the probability of CHD with use of the Framingham risk point-scoring formula and emphasize the multifactorial benefits of drug therapy as an adjunct to lifestyle changes.