Revised NCEP Guidelines for the Management of Hypercholesterolemia: An Overview

In addition to intensive treatment of CHD, a major focus of the revised guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) for cholesterol testing and management is on primary prevention in persons with multiple risk factors. NCEP ATP III now guides in the determination of risk based on designations of CHD risk equivalents and the Framingham 10-year risk assessment for patients who have 2 or more risk factors and therefore require more intensive therapy. The updated guidelines also identify patients who fit criteria for the metabolic syndrome. The guidelines now establish the optimal low-density lipoprotein cholesterol (LDL-C) level as <100 mg/dL and the minimally acceptable high-density lipoprotein cholesterol (HDL-C) level as 40 mg/dL. Other new recommendations include step-by-step risk management to assess the need for therapeutic lifestyle changes or drug therapy to lower LDL-C levels. This introduction will focus on new features of the guidelines and their application to prospective patients.