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National Cholesterol Education Program

Adult Treatment Panel III (ATP III) Guidelines Slide Set

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SLIDE 1: ATP III Guidelines
Specific Dyslipidemias

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SLIDE 2: Specific Dyslipidemias: Very High LDL Cholesterol (greater than or equal to190 mg/dL)
Causes and Diagnosis

• Genetic disorders
  • Monogenic familial hypercholesterolemia
  • Familial defective apolipoprotein B-100
  • Polygenic hypercholesterolemia
• Family testing to detect affected relatives

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SLIDE 3: Specific Dyslipidemias: Very High LDL Cholesterol (greater than or equal to190 mg/dL) (continued)
Management

• LDL-lowering drugs
  • Statins (higher doses)
  • Statins + bile acid sequestrants
  • Statins + bile acid sequestrants + nicotinic acid

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SLIDE 4: Specific Dyslipidemias: Elevated Triglycerides
Classification of Serum Triglycerides

• Normal <150 mg/dL
• Borderline high 150-199 mg/dL
• High 200-499 mg/dL
• Very high greater than or equal to500 mg/dL

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SLIDE 5: Specific Dyslipidemias: Elevated Triglycerides (greater than or equal to150 mg/dL)
Causes of Elevated Triglycerides

• Obesity and overweight
• Physical inactivity
• Cigarette smoking
• Excess alcohol intake

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SLIDE 6: Specific Dyslipidemias: Elevated Triglycerides
Causes of Elevated Triglycerides (continued)

• High carbohydrate diets (>60% of energy intake)
• Several diseases (type 2 diabetes, chronic renal failure, nephrotic syndrome)
• Certain drugs (corticosteroids, estrogens, retinoids, higher doses of beta-blockers)
• Various genetic dyslipidemias

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SLIDE 7: Specific Dyslipidemias: Elevated Triglycerides (continued)
Non-HDL Cholesterol: Secondary Target

• Non-HDL cholesterol=VLDL + LDL cholesterol=(Total Cholesterol - HDL cholesterol)
• VLDL cholesterol: denotes atherogenic remnant lipoproteins
• Non-HDL cholesterol: secondary target of therapy when serum triglycerides are greater than or equal to200 mg/dL (esp. 200-499 mg/dL)
• Non-HDL cholesterol goal: LDL-cholesterol goal + 30 mg/dL

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SLIDE 8: >Comparison of LDL Cholesterol and Non-HDL Cholesterol Goals for Three Risk Categories

Risk Category	LDL-C Goal (mg/dL)	Non-HDL-C Goal (mg/dL)
CHD and CHD Risk Equivalent (10-year risk for CHD >20%	<100	>130
Multiple (2+) Risk Factors and 10-year risk <20%	>130	.160
0-1 Risk Factor	<160	<190

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SLIDE 9: Specific Dyslipidemias: Elevated Triglycerides
Non-HDL Cholesterol: Secondary Target

• Primary target of therapy: LDL cholesterol
• Achieve LDL goal before treating non-HDL cholesterol
• Therapeutic approaches to elevated non-HDL cholesterol
  • Intensify therapeutic lifestyle changes
  • Intensify LDL-lowering drug therapy
  • Nicotinic acid or fibrate therapy to lower VLDL

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SLIDE 10: Specific Dyslipidemias: Elevated Triglycerides
Management of Very High Triglycerides (greater than or equal to500 mg/dL)

• Goal of therapy: prevent acute pancreatitis
• Very low fat diets (15% of caloric intake)
• Triglyceride-lowering drug usually required (fibrate or nicotinic acid)
• Reduce triglycerides before LDL lowering

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SLIDE 11: Specific Dyslipidemias: Low HDL Cholesterol
Causes of Low HDL Cholesterol (<40 mg/dL)

• Elevated triglycerides
• Overweight and obesity
• Physical inactivity
• Type 2 diabetes
• Cigarette smoking
• Very high carbohydrate intakes (>60% energy)
• Certain drugs (beta-blockers, anabolic steroids, progestational agents)

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SLIDE 12: Specific Dyslipidemias: Low HDL Cholesterol
Management of Low HDL Cholesterol

• LDL cholesterol is primary target of therapy
• Weight reduction and increased physical activity (if the metabolic syndrome is present)
• Non-HDL cholesterol is secondary target of therapy (if triglycerides greater than or equal to200 mg/dL)
• Consider nicotinic acid or fibrates (for patients with CHD or CHD risk equivalents)

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SLIDE 13: Specific Dyslipidemias: Diabetic Dyslipidemia

• Lipoprotein pattern: atherogenic dyslipidemia (high TG, low HDL, small LDL particles)
• LDL-cholesterol goal: <100 mg/dL
• Baseline LDL-cholesterol greater than or equal to130 mg/dL
  • Most patients require LDL-lowering drugs
• Baseline LDL-cholesterol 100-129 mg/dL
  • Consider therapeutic options
• Baseline triglycerides: greater than or equal to200 mg/dL
  • Non-HDL cholesterol: secondary target of therapy

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