Update on cholesterol guidelines: more-intensive treatment options for higher risk patients

A 2004 update to the National Cholesterol Education Program's (NCEP) clinical practice guidelines on cholesterol management advises physicians to consider new, more intensive treatment options for people at high and moderately high risk for a heart attack. These options include setting lower treatment goals for LDL ("bad") cholesterol and initiating cholesterol-lowering drug therapy at lower LDL thresholds.

The update,* published in the July 13 issue of Circulation: Journal of the American Heart Association, is endorsed by the National Heart, Lung, and Blood Institute (NHLBI), the American College of Cardiology, and the American Heart Association. The document is based on a review of 5 major clinical trials of statin therapy** conducted since the 2001 release of the NCEP's cholesterol guidelines known as the Adult Treatment Panel (ATP) III Report. NHLBI, a component of the National Institutes of Health, coordinates the NCEP.

"The recent trials add to the evidence that when it comes to LDL (bad) cholesterol, lower is better for persons with high risk for heart attack," said NHLBI Acting Director Barbara Alving, M.D. "These trials show a direct relationship between lower LDL cholesterol levels and reduced risk for major coronary events. So, it is important to consider more intensive treatment for people at very high risk," she added.

Major recommendations in the update include:

  • *High and Very High Risk: For high-risk patients, the overall goal remains an LDL level of less than 100 mg/dL. But for people at very high risk, a group that is considered a "sub-set" of the high-risk category, the update offers a new therapeutic option of treating to under 70 mg/dL. For very high-risk patients whose LDL levels are already below 100 mg/dL, there is also an option to use drug therapy to reach the less than 70 mg/dL goal.

    For the overall category of high-risk patients, the update lowers the threshold for drug therapy to

Contact: NHLBI Communications Office
NIH/National Heart, Lung, and Blood Institute

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