|Volume 6 Issue 195 Published - 14:00 UTC 08:00 EST 13-Jul-2004 Next Update - 14:00 UTC 08:00 EST 14-Jul-2004||Editor: Susan K. Boyer, RN
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Update on cholesterol guidelines: more-intensive treatment options for higher risk patients
A 2004 update to the National Cholesterol Education Program's (NCEP) clinical practice guidelines on cholesterol management advises physicians to consider new, more intensive treatment options for people at high and moderately high risk for a heart attack. These options include setting lower treatment goals for LDL ("bad") cholesterol and initiating cholesterol-lowering drug therapy at lower LDL thresholds.
The update,* published in the July 13 issue of Circulation: Journal of the American Heart Association, is endorsed by the National Heart, Lung, and Blood Institute (NHLBI), the American College of Cardiology, and the American Heart Association. The document is based on a review of 5 major clinical trials of statin therapy** conducted since the 2001 release of the NCEP's cholesterol guidelines known as the Adult Treatment Panel (ATP) III Report. NHLBI, a component of the National Institutes of Health, coordinates the NCEP.
"The recent trials add to the evidence that when it comes to LDL (bad) cholesterol, lower is better for persons with high risk for heart attack," said NHLBI Acting Director Barbara Alving, M.D. "These trials show a direct relationship between lower LDL cholesterol levels and reduced risk for major coronary events. So, it is important to consider more intensive treatment for people at very high risk," she added.
Major recommendations in the update include:
The report emphasizes the importance of therapeutic lifestyle changes (TLC --intensive use of nutrition, physical activity, and weight control) for cholesterol management.
"Lifestyle changes continue to be an essential part of controlling cholesterol. TLC has the potential to reduce cardiovascular risk through several mechanisms beyond LDL lowering," said Scott Grundy, M.D., director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas and chair of the NCEP working group that developed the update report.
Like ATP III, the update addresses and emphasizes cholesterol lowering in older persons (age 65 or above). High-risk older persons with established cardiovascular disease are included in the recommendations for intensive LDL-lowering therapy.
"Although the update suggests that physicians use their clinical judgment to determine whether intensive LDL-lowering therapy is warranted in older persons, these people should not be excluded from the benefits of LDL-lowering treatment just because of age," said NCEP Coordinator James Cleeman, M.D.
A comparison of the key modifications in the update with the ATP III recommendations follows:
*Grundy SM, Cleeman JI, Bairey Merz CN, Brewer HB, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Stone NJ; for the Coordinating Committee of the National Cholesterol Education Program. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004; 110:227-239.