The National Cholesterol Education Program (NCEP) recently released an update to its cholesterol management guidelines and now advocates lowering treatment goals for some patients by as much as 30%. The clinical practice guidelines – the Adult Treatment Panel III (ATP III) report – were first published in 2001, but findings from several new studies warranted this update. The revisions focus primarily on the management of patients at high risk of heart attack.

High risk has been defined by the NCEP as those patients who have coronary heart disease, disease of blood vessels to the brain or extremities, or diabetes, or 2 or more risk factors, including smoking and high blood pressure, that create a greater than 20 percent chance that the patient will have a heart attack within 10 years. Those at very high risk have cardiovascular disease (CVD) plus either multiple, severe, or poorly controlled risk factors, such as diabetes, smoking, and metabolic syndrome or have been hospitalized already for an acute coronary syndrome, such as a heart attack.

The revised guidelines are based on results from five clinical trials on statin (cholesterol-lowering) therapy that were conducted since the first ATP III report’s publication. The results served to confirm many of the original ATP III recommendations, but also warranted a more aggressive position. The new guidelines call for lowering the treatment goals for LDL (“bad” cholesterol) and for starting cholesterol-lowering therapies at lower LDL levels for certain patients. For those at very high risk, the guidelines allow for treating to get LDL levels under 70 mg/dL, when in the original guidelines the goal was 100 mg/dL. For those at moderately high risk, the recommendation still is a treatment goal of an LDL below 130 mg/dL, but with the option to reduce the goal to under 100 mg/dL. The revised guidelines also emphasize the importance of lifestyle modifications (such as diet and exercise) for those at high or moderately high risk, regardless of their actual LDL levels.

As findings from more studies are published, we may see additional updates to these guidelines. In the meantime, the message seems to be that for persons at high risk for heart attack, the lower LDL level they can achieve the better for their health. To review the guidelines, see the links below.