Assessment

NCEP guidelines

NCEP ATP III Management Guidelines:
The two main ways of reducing LDL-C levels are therapeutic lifestyle changes and cholesterol-lowering therapy.¹

In individuals with 0–1 additional risk factors and whose LDL-C levels are >160 mg/dL (4.1 mmol/L), lifestyle changes are recommended. Cholesterol-lowering therapy should be considered when LDL-C levels are >190 mg/dL
(5.0 mmol/L), and is optional depending on clinical judgement at LDL-C levels of 160–189 mg/dL (4.1-5.0 mmol/L). The recommended LDL-C level to achieve in this risk category is <160 mg/dL (4.1 mmol/L).

In individuals with >2 risk factors, the guidelines recommend lifestyle changes for patients with 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 cholesterol-lowering therapy should be considered:

10-year CHD risk of 10–20%, cholesterol-lowering therapy should be considered if a patient’s LDL-C level remains >130 mg/dL (3.4 mmol/L), after 3 months of lifestyle changes, with the therapeutic aim of reducing short- and long-term cardiovascular risk. In elderly patients (>65 years), clinical judgement about the intensity of cholesterol-lowering therapy is required.
10-year CHD risk of <10%, cholesterol-lowering therapy should be considered if a patient’s LDL-C level remains >160 mg/dL (4.1 mmol/L), with the therapeutic aim of reducing long-term cardiovascular risk. If LDL-C is
<160 mg/dL (4.1 mmol/L) following lifestyle changes, cholesterol-lowering therapy is not generally recommended as short-term risk is not high.

In individuals at the highest risk (CHD and CHD risk equivalents, 10-year risk >20%), the recommended point at which lifestyle changes should be initiated is an LDL-C level of >100 mg/dL (2.6 mmol/L). The guidelines recommend that cholesterol-lowering therapy should be considered in this category simultaneously with lifestyle changes in patients with LDL-C levels >130 mg/dL (3.4 mmol/L). However, if LDL-C levels are between 100 and 129 mg/dL
(2.6 and 3.4 mmol/L), cholesterol-lowering therapy is optional.

Cardiovascular risk factors that can influence therapy recommendations in favour of cholesterol-lowering therapy include: a severe single risk factor; heavy 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%.

Reference:
1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA
2001:285;2486–2497.