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

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SLIDE 2: Prevention With LDL-Lowering Therapy
Public Health Approach

• Reduced intakes of saturated fat and cholesterol
• Increased physical activity
• Weight control

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SLIDE 3: Primary Prevention
Goals of Therapy

• Long-term prevention (>10 years)
• Short-term prevention (10 years)

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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)

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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 100 mg/dL)

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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	100	130 (100–129: drug optional)
2+ Risk Factors (10-year risk 20%)	<130	130	10-year risk 10–20%: 130 10-year risk <10%: 160
0–1 Risk Factor	<160	160	190 (160–189: LDL-lowering drug optional)

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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	100 mg/dL	130 mg/dL (100–129 mg/dL: drug optional)

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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	130 mg/dL	10-year risk 10–20%: 130 mg/dL 10-year risk <10%: 160 mg/dL

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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	160 mg/dL	190 mg/dL (160–189 mg/dL: LDL-lowering drug optional)

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SLIDE 10: LDL-Lowering Therapy in Patients With CHD and CHD Risk Equivalents
Baseline LDL Cholesterol: 130 mg/dL

• Intensive lifestyle therapies
• Maximal control of other risk factors
• Consider starting LDL-lowering drugs simultaneously with lifestyle therapies

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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

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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

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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 130 mg/dL
• Consider drug therapy if LDL-C is 130 mg/dL after 3 months of lifestyle therapies

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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 130 mg/dL
• Consider drug therapy if LDL-C is 160 mg/dL after 3 months of lifestyle therapies

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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 160 mg/dL
• If LDL-C is 190 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

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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)

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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

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