National Cholesterol Education Program
Adult Treatment Panel III (ATP III) Guidelines Slide Set
1 | 2 | 3
| 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19
Return to Menu
SLIDE 1: ATP III Guidelines
Drug Therapy
Return to Top
SLIDE 2: Drug Therapy
HMG CoA Reductase Inhibitors (Statins)
- Reduce LDL-C 18-55% & TG 7-30%
- Raise HDL-C 5-15%
- Major side effects
- Myopathy
- Increased liver enzymes
- Contraindications
- Absolute: liver disease
- Relative: use with certain drugs
Return to Top
SLIDE 3: HMG CoA Reductase Inhibitors (Statins)
| Statin |
Dose Range |
| Lovastatin |
20-80 mg |
| Pravastatin |
20-40 mg |
| Simvastatin |
20-80 mg |
| Fluvastatin |
20-80 mg |
| Atorvastatin |
10-80 mg |
| Cerivastatin |
0.4-0.8 mg |
Return to Top
SLIDE 4: HMG CoA Reductase Inhibitors (Statins)
(continued)
Demonstrated Therapeutic Benefits
- Reduce major coronary events
- Reduce CHD mortality
- Reduce coronary procedures (PTCA/CABG)
- Reduce stroke
- Reduce total mortality
Return to Top
SLIDE 5: Drug Therapy
Bile Acid Sequestrants
- Major actions
- Reduce LDL-C 15-30%
- Raise HDL-C 3-5%
- May increase TG
- Side effects
- GI distress/constipation
- Decreased absorption of other drugs
- Contraindications
- Dysbetalipoproteinemia
- Raised TG (especially >400 mg/dL)
Return to Top
SLIDE 6: Bile Acid Sequestrants
| Drug |
Dose Range |
| Cholestyraminevastatin |
4-16 g |
| Colestipol |
5-20 g |
| Colesevelam |
2.6-3.8 g |
Return to Top
SLIDE 7: Bile Acid Sequestrants (continued)
Demonstrated Therapeutic Benefits
- Reduce major coronary events
- Reduce CHD mortality
Return to Top
SLIDE 8: Drug Therapy
Nicotinic Acid
- Major actions
- Lowers LDL-C 5-25%
- Lowers TG 20-50%
- Raises HDL-C 15-35%
- Side effects: flushing, hyperglycemia, hyperuricemia, upper GI distress,
hepatotoxicity
- Contraindications: liver disease, severe gout, peptic ulcer
Return to Top
SLIDE 9: Nicotinic Acid
| Drug Form |
Dose Range |
| Immediate release (crystalline) |
1.5-3 g |
| Extended release |
1-2 g |
| Sustained release |
1-2 g |
Return to Top
SLIDE 10: Nicotinic Acid (continued)
Demonstrated Therapeutic Benefits
- Reduces major coronary events
- Possible reduction in total mortality
Return to Top
SLIDE 11: Drug Therapy
Fibric Acids
- Major actions
- Lower LDL-C 5-20% (with normal TG)
- May raise LDL-C (with high TG)
- Lower TG 20-50%
- Raise HDL-C 10-20%
- Side effects: dyspepsia, gallstones, myopathy
- Contraindications: Severe renal or hepatic disease
Return to Top
SLIDE 12: Fibric Acids
| Drug |
Dose |
| Gemfibrozil |
600 mg BID |
| Fenofibrate |
200 mg QD |
| Clofibrate |
1000 mg BID |
Return to Top
SLIDE 13: Fibric Acids (continued)
Demonstrated Therapeutic Benefits
- Reduce progression of coronary lesions
- Reduce major coronary events
Return to Top
SLIDE 14: Secondary Prevention: Drug Therapy for CHD and
CHD Risk Equivalents
- LDL-cholesterol goal: <100 mg/dL
- Most patients require drug therapy
- First, achieve LDL-cholesterol goal
- Second, modify other lipid and non-lipid risk factors
Return to Top
SLIDE 15: Secondary Prevention: Drug Therapy for CHD and
CHD Risk Equivalents (continued)
Patients Hospitalized for Coronary Events or Procedures
- Measure LDL-C within 24 hours
- Discharge on LDL-lowering drug if LDL-C
130 mg/dL
- Consider LDL-lowering drug if LDL-C is 100-129 mg/dL
- Start lifestyle therapies simultaneously with drug
Return to Top
SLIDE 16: Progression of Drug Therapy in Primary
Prevention
Initiate LDL-lowering drug therapy
- Start statin or bile acid sequestrant or nicotinic acid
If LDL goal not achieved, intensify LDL-lowering therapy
- Consider higher dose of statin or add a bile acid sequestrant or nicotinic
acid
If LDL goal not achieved, intensify drug therapy or refer to a lipid
specialist
- If LDL goal achieved, treat other lipid risk factors
Monitor response and adherence to therapy
Return to Top
SLIDE 17: Drug Therapy for Primary Prevention
First Step
- Initiate LDL-lowering drug therapy (after 3 months of lifestyle therapies)
- Usual drug options
- Statins
- Bile acid sequestrant or nicotinic acid
- Continue therapeutic lifestyle changes
- Return visit in about 6 weeks
Return to Top
SLIDE 18: Drug Therapy for Primary Prevention
Second Step
- Intensify LDL-lowering therapy (if LDL goal not achieved)
- Therapeutic options
- Higher dose of statin
- Statin + bile acid sequestrant
- Statin + nicotinic acid
- Return visit in about 6 weeks
Return to Top
SLIDE 19: Drug Therapy for Primary Prevention
(continued)
Third Step
- If LDL goal not achieved, intensify drug therapy or refer to a lipid
specialist
- Treat other lipid risk factors (if present)
- High triglycerides (200 mg/dL)
- Low HDL cholesterol (<40 mg/dL)
- Monitor response and adherence to therapy (Q 4-6 months)
Return to Top