Archived page
National Cholesterol Education Program
Adult Treatment Panel III (ATP III) Guidelines Slide Set
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SLIDE 1: ATP III Guidelines
Goals and Treatment Overview
SLIDE 2: Prevention With LDL-Lowering Therapy
Public Health Approach
- Reduced intakes of saturated fat and cholesterol
- Increased physical activity
- Weight control
SLIDE 3: Primary Prevention
Goals of Therapy
- Long-term prevention (>10 years)
- Short-term prevention (
10 years)
SLIDE 4: Causes of Secondary Dyslipidemia
- Diabetes
- Hypothyroidism
- Obstructive liver disease
- Chronic renal failure
- Drugs that raise LDL cholesterol and lower HDL cholesterol (progestins, anabolic steroids, and corticosteroids)
SLIDE 5: Secondary Prevention With LDL-Lowering Therapy
- Benefits: reduction in total mortality, coronary mortality, major coronary events, coronary procedures, and stroke
- LDL cholesterol goal: <100 mg/dL
- Includes CHD risk equivalents
- Consider initiation of therapy during hospitalization (if LDL greater than or equal to100 mg/dL)
SLIDE 6: LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories
| Risk Category | LDL Goal (mg/dL) | LDL Level at Which to Initiate Therapeutic Lifestyle Changes (TLC) (mg/dL) | LDL Level at Which to Consider Drug Therapy (mg/dL) |
|---|---|---|---|
| CHD or CHD Risk Equivalents (10-year risk >20%) | <100 | greater than or equal to100 | greater than or equal to130 (100–129: drug optional) |
| 2+ Risk Factors (10-year risk 20%) | <130 | greater than or equal to130 | 10-year risk 10–20%: greater than or equal to130 10-year risk <10%: greater than or equal to160 |
| 0–1 Risk Factor | <160 | greater than or equal to160 | greater than or equal to190 (160–189: LDL-lowering drug optional) |
SLIDE 7: LDL Cholesterol Goal and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Patients with CHD and CHD Risk Equivalents (10-Year Risk >20%)
| LDL Goal | LDL Level at Which to Initiate Therapeutic Lifestyle Changes (TLC) | LDL Level at Which to Consider Drug Therapy |
|---|---|---|
| <100 mg/dL | greater than or equal to100 mg/dL | greater than or equal to130 mg/dL (100–129 mg/dL: drug optional) |
SLIDE 8: LDL Cholesterol Goal and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Patients with Multiple Risk Factors (10-Year Risk 20%)
| LDL Goal | LDL Level at Which to Initiate Therapeutic Lifestyle Changes (TLC) | LDL Level at Which to Consider Drug Therapy |
|---|---|---|
| <130 mg/dL | greater than or equal to130 mg/dL | 10-year risk 10–20%: greater than or equal to130 mg/dL 10-year risk <10%: greater than or equal to160 mg/dL |
SLIDE 9: LDL Cholesterol Goal and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Patients with 0-1 Risk Factor
| LDL Goal | LDL Level at Which to Initiate Therapeutic Lifestyle Changes (TLC) | LDL Level at Which to Consider Drug Therapy |
|---|---|---|
| <160 mg/dL | greater than or equal to160 mg/dL | greater than or equal to190 mg/dL (160–189 mg/dL: LDL-lowering drug optional) |
SLIDE 10: LDL-Lowering Therapy in Patients With CHD and CHD Risk Equivalents
Baseline LDL Cholesterol: greater than or equal to130 mg/dL
- Intensive lifestyle therapies
- Maximal control of other risk factors
- Consider starting LDL-lowering drugs simultaneously with lifestyle therapies
SLIDE 11: LDL-Lowering Therapy in Patients With CHD and CHD Risk Equivalents
Baseline (or On-Treatment) LDL-C: 100-129 mg/dL
Therapeutic Options:
- LDL-lowering therapy
- Initiate or intensify lifestyle therapies
- Initiate or intensify LDL-lowering drugs
- Treatment of metabolic syndrome
- Emphasize weight reduction and increased physical activity
- Drug therapy for other lipid risk factors
- For high triglycerides/low HDL cholesterol
- Fibrates or nicotinic acid
SLIDE 12: LDL-Lowering Therapy in Patients With CHD and CHD Risk Equivalents
Baseline LDL-C: <100 mg/dL
- Further LDL lowering not required
- Therapeutic Lifestyle Changes (TLC) recommended
- Consider treatment of other lipid risk factors
- Elevated triglycerides
- Low HDL cholesterol
- Ongoing clinical trials are assessing benefit of further LDL lowering
SLIDE 13: LDL-Lowering Therapy in Patients With Multiple (2+) Risk Factors and 10-Year Risk 20%
10-Year Risk 10-20%
- LDL-cholesterol goal <130 mg/dL
- Aim: reduce both short-term and long-term risk
- Immediate initiation of Therapeutic Lifestyle Changes (TLC) if LDL-C is greater than or equal to130 mg/dL
- Consider drug therapy if LDL-C is greater than or equal to130 mg/dL after 3 months of lifestyle therapies
SLIDE 14: LDL-Lowering Therapy in Patients With Multiple (2+) Risk Factors and 10-Year Risk 20%
10-Year Risk <10%
- LDL-cholesterol goal: <130 mg/dL
- Therapeutic aim: reduce long-term risk
- Initiate therapeutic lifestyle changes if LDL-C is greater than or equal to130 mg/dL
- Consider drug therapy if LDL-C is greater than or equal to160 mg/dL after 3 months of lifestyle therapies
SLIDE 15: LDL-Lowering Therapy in Patients With 0-1 Risk Factor
- Most persons have 10-year risk <10%
- Therapeutic goal: reduce long-term risk
- LDL-cholesterol goal: <160 mg/dL
- Initiate therapeutic lifestyle changes if LDL-C is greater than or equal to160 mg/dL
- If LDL-C is greater than or equal to190 mg/dL after 3 months of lifestyle therapies, consider drug therapy
- If LDL-C is 160-189 mg/dL after 3 months of lifestyle therapies, drug therapy is optional
SLIDE 16: LDL-Lowering Therapy in Patients With 0-1 Risk Factor and LDL-Cholesterol 160-189 mg/dL (after lifestyle therapies)
Factors Favoring Drug Therapy
- Severe single risk factor
- Multiple life-habit risk factors and emerging risk factors (if measured)
SLIDE 17: Benefit Beyond LDL Lowering: The Metabolic Syndrome as a Secondary Target of Therapy
General Features of the Metabolic Syndrome
- Abdominal obesity
- Atherogenic dyslipidemia
- Elevated triglycerides
- Small LDL particles
- Low HDL cholesterol
- Raised blood pressure
- Insulin resistance (± glucose intolerance)
- Prothrombotic state
- Proinflammatory state
Archived page, reproduced from a 2012 copy. It is reference material, not current guidance.