NCEP ATP III Management Guidelines

The two main ways of reducing LDL-C levels are therapeutic lifestyle changes (TLC) and drug therapy.¹

• In individuals with 0–1 risk factor and whose LDL-C levels are ?160 mg/dL (4.1 mmol/L), TLC are recommended. Drug therapy should be considered when LDL-C levels are ?190 mg/dL (5 mmol/L) despite TLC, and is optional depending on clinical judgement at LDL-C levels of 160–189 mg/dL (4.1-5 mmol/L). The goal for LDL-C in this risk category is <160 mg/dL (4.1 mmol/L).
• In patients with ?2 risk factors, the guidelines recommend that TLC are initiated at LDL-C levels of ?130 mg/dL (3.4 mmol/L), with the aim of <130 mg/dL (3.4 mmol/L). Two subcategories define when drug therapy should be considered; in those with a:
  • - 10-year CHD risk of 10–20%, drug therapy should be considered if LDL-C levels remain ?130 mg/dL (3.4 mmol/L), after 3 months of TLC, with the therapeutic aim to reduce short- and long-term CHD risk. In the elderly (?65 years), clinical judgement is required for how intensely to apply these guidelines.
  • - 10-year CHD risk of <10%, drug therapy should be considered at LDL-C levels ?160 mg/dL (4.1 mmol/L), with the therapeutic aim to reduce long-term risk. If LDL-C is <160 mg/dL (4.1 mmol/L) on TLC alone, drugs are not generally recommended as short-term risk is not high.
• In patients at highest risk (CHD and CHD risk equivalents, 10-year risk >20%), the recommended point at which TLC should be initiated is an LDL-C level of ?100 mg/dL (2.6 mmol/L). The guidelines recommend that drug therapy be considered in this category simultaneously with TLC in persons whose LDL-C levels are ?130 mg/dL (3.4 mmol/L); drug therapy is optional, however, if LDL-C levels are between 100 and 129 mg/dL (2.6-3.4 mmol/L).

Factors favouring the use of drugs include: a severe single risk factor; heavy cigarette smoking, poorly controlled hypertension, strong family history of premature CHD, very low HDL-C; multiple life-habit and emerging risk factors; and a 10-year CHD risk approaching 10%.

Click to enlarge

*Adapted from JAMA 2001;285:2486–2497, with permission from the American Medical Association. All rights reserved.

Read more about NCEP ATP III: LDL-C Goals...

^ Top