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NCEP Guidelines for Cholesterol Management

Sponsoring Organization: This executive summary of the 1993 guidelines revision was authored by the National Heart, Lung, and Blood Institute's (NHLBI's) National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol.

Purpose: The NHLBI has developed these new cholesterol guidelines to help clinicians integrate current findings into clinical practice, with new emphasis on assessing patients' underlying risk for coronary heart disease (CHD).

Key Points:

1. Elevated LDL cholesterol is a major cause of CHD. Evaluation of LDL levels should be a key component of an overall risk-assessment strategy.

2. In people 20 or older, a fasting lipoprotein profile (total, LDL, and HDL cholesterol levels, plus triglyceride level) should constitute initial screening for hypercholesterolemia and should be obtained every 5 years. Follow-up profiles should be obtained if total cholesterol is 200 mg/dL or HDL cholesterol is <40 mg/dL.

3. For people without clinically manifest CHD, 10-year CHD risk should be assessed with the newly modified Framingham Risk Prediction Score. Ten-year CHD risk calculations should be used with other risk-factor data and cholesterol-screening results to guide management, including consideration of lifestyle changes and drug therapy. See table 5 of the executive summary for calibration details.

4. Regardless of CHD status, all diabetics should have their LDL levels treated to the target of <100 mg/dL. With the new emphasis on underlying risk, diabetics no longer should be considered candidates for just primary prevention.

5. More intensive "therapeutic lifestyle changes" are recommended as first-line therapy. These include weight reduction, increased physical activity, and diets with <200 mg/day of cholesterol and <7 percent of calories from saturated fat.

6. The guidelines identify the metabolic syndrome as a secondary target of therapy. Management of this disorder should be directed at underlying causes, such as obesity and inactivity, and at related nonlipid and lipid risk factors.

7. The guidelines recommend treating borderline high triglyceride levels (newly defined as 150-190 mg/dL) with weight control, physical activity, and medication (if necessary).

8. Cholesterol lowering with statins has been shown to reduce the incidence of adverse cardiovascular events in women with and without CHD. Hormone replacement therapy is not recommended as an alternative to cholesterol-lowering drugs in postmenopausal women with CHD.

Comment: These guidelines expand the indications for aggressive lipid lowering to new patient subsets. A key change is modification of the Framingham Risk Prediction Score to estimate CHD risk. Also noteworthy is the expert panel's inclusion of recommendations to ensure guideline implementation and adherence to therapy. The complete guidelines are available on the Web at http://www.nhlbi.nih.gov

— JM Foody

Published in Journal Watch Cardiology June 15, 2001

Citation(s):

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the 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). JAMA 2001 May 16 285 2486-2497.

• Original article (Subscription may be required)
• Medline abstract (Free)

Lauer MS and Fontanarosa PB. Updated guidelines for cholesterol management. JAMA 2001 May 16 285 2508-2509.

• Original article (Subscription may be required)
• Medline abstract (Free)