Summary of ATP III Recommendations

Elevated LDL cholesterol is the major cause of coronary heart disease thus ATP III continues to identify elevated LDL as the primary target of cholesterollowering therapy. A asic principle of prevention is that the intensity of ris!-reduction therapy is adjusted ased on the person"s a solute ris!. #is! assessment is ased on measurement of the LDL cholesterol and identification of accompanying ris! determinant.

STEP ONE: SCREENING

In all adults age $% or older & a ' & ($ hour fasting lipoprotein profile )total cholesterol* low density lipoprotein )LDL+ cholesterol* high density lipoprotein ),DL+ cholesterol* and triglyceride )T-+ should e performed once every . years. If a fasting lipid panel can not e done* then only the total cholesterol and ,DL is appropriate for use. ATP III Classification of LDL, Total, and DL C!olesterol "m#$dL% LDL C!olesterol & Primary Tar#et of T!era'y /(%% 0ptimal (%%-($' 1ear optimal2a ove optimal (3%-(.' 4orderline high (5%-(6' ,igh 7('% 8ery high Total C!olesterol /$%% Desira le $%%-$3' 4orderline high 7$9% ,igh DL C!olesterol /9% Low 75% ,igh

STEP T(O: ASSESS)ENT *OR PRESENCE O* IG RIS+ CORONAR, EART DISEASE E-.I/ALENTS
Identify 'resence of clinical at!erosclerotic disease t!at confers !i#! ris0 for coronary !eart disease "C D% e1ents "C D ris0 e2ui1alent%:

:linical :,D

;ymptomatic carotid artery disease Peripheral arterial disease A dominal aortic aneurysm Dia etes is considered a :,D ris! e<uivalent in ATP III

STEP T REE: ASSESS)ENT O* )A3OR RIS+ *ACTORS

Determine presence of major ris! factors )other than LDL+ That =odify LDL -oals>

:igarette smo!ing ,ypertension )4P ?(9%2'% mm,g or on antihypertensive medication+ Low ,DL cholesterol )/9% mg2dL+@ Aamily history of premature :,D ):,D in male first degree relative /.. yearsB :,D in female first degree relative /5. years+ Age )men ?9. yearsB women ?.. years+

*HDL cholesterol 760 mg/dL counts as a negative risk factor; its presence removes one risk factor from the total count.

STEP *O.R: I* 4 OR )ORE )A3OR RIS+ *ACTORS OT ER T AN LDL ARE PRESENT T EN ASSESS 567,EAR C D RIS+
If $C ris! factors )other than LDL+ are present without :,D or :,D ris! e<uivalent* assess (%-year )short-term+ :,D ris! )see Aramingham ta les+. Three levels of (%-year ris! are>

?$%D E this is considered a :,D ris! e<uivalent (%-$%D /(%D

A (% year ris! factor ?$%D means that $% out of (%% individuals will develop coronary heart disease or a coronary event within (% years.

STEP *I/E: DETER)INE T E RIS+ CATEGOR,

Determine ris! category y>

Esta lishing LDL goal of therapy Determining need for therapeutic lifestyle changes )TL:+ Determining level for drug consideration

LDL C!olesterol Goals and Cutoff Points for T!era'eutic Lifestyle C!an#es "TLC% and Dru# T!era'y in Different Ris0 Cate#ories LDL level at which LDL level at which to consider drug #is! :ategory LDL -oal to initiate TL: therapy :,D or :,D #is! /(%% mg2dL7(%% mg2dL 7(3% mg2dL

E<uivalents )(% year ris! factor ?$%D+ $C #is! Aactors )(% year ris! factor /(3% mg2dL7(3% mg2dL F$%D+ %-( #is! Aactor /(5% mg2dL7(5% mg2dL

)(%%-($' mg2dL> drug optional+@ (%-year ris! (%-$%D> 7(3% mg2dL (%-year ris! /(%D> 7(5% mg2dL 7('% mg2dL )(5%-(6' mg2dL> LDL-lowering drug optional+

* !ome authorities recommend use of LDL"lo#ering drugs in this categor$ if an LDL cholesterol %&00 mg/dL cannot 'e achieved '$ therapeutic lifest$le changes. (thers prefer use of drugs that primaril$ modif$ trigl$cerides and HDL) e.g.) nicotinic acid or fi'rate. *linical +udgment also ma$ call for deferring drug therap$ in this su'categor$. ,lmost all people #ith 0"& risk factor have a &0"$ear risk %&0-) thus &0"$ear risk assessment in people #ith 0"& risk factor is not necessar$.