Archived page

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 greater than or equal to130 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 (greater than or equal to200 mg/dL)
  • Low HDL cholesterol (<40 mg/dL)
• Monitor response and adherence to therapy (Q 4-6 months)

Return to Top