NCEP ATP III: LDL-C Goals (2004 proposed modifications)
{"Image DocumentName": "NCEP ATP III: LDL-C Goals (2004 proposed modifications)", "Image ImageDescription": "High Risk. CHD or CHD risk equivalents. (10-yr risk >20%) LDL-C level Lower Risk. < 2 risk factors. Moderately High Risk. \u2265 2 risk factors. (10-yr risk 10-20%) goal mg/dL or optional. 70 mg/dL  Moderate Risk. (10-yr risk <10%) 100 mg/dL  Based on recent clinical trial evidence, an NCEP report1 has been published recommending tighter control of cholesterol management. The trials support an LDL-C goal of <100 mg/dL in high-risk patients, and the inclusion of diabetes in the high-risk category. All patients with CHD or CHD risk equivalents are at high-risk. Therapeutic lifestyle changes (TLC) remain an essential part of clinical management. In patients at high risk (CHD and CHD risk equivalents, 10-year risk >20%), the recommended LDL-C goal is <100 mg/dL, but when risk is very high, an LDL-C goal of <70 mg/dL (1.8 mmol/dL) is a proposed therapeutic option. Patients at very high risk are those with established CVD plus: multiple major risk factors (especially diabetes); severe and poorly controlled risk factors (especially continued cigarette smoking); multiple risk factors of the metabolic syndrome and patients with acute coronary syndrome. The recommended point at which TLC should be initiated is an LDL-C level of \uf0b3100 mg/dL (2.6 mmol/L). The guidelines recommend that drug therapy be considered in this category simultaneously with TLC in persons whose LDL-C levels are \uf0b3100 mg/dL (2.6 mmol/L). In patients at moderately high risk (\uf0b32 risk factors and 10-year CHD risk of 10\u201320%) the guidelines recommend that TLC are initiated at LDL-C levels of \uf0b3130 mg/dL (3.4 mmol/L), with the aim of <130 mg/dL (3.4 mmol/L), but an LDL-C goal of <100 mg/dL (2.6 mmol/L) is a therapeutic option based on clinical trial evidence. This also applies to patients with a baseline LDL-C of mg/dL. Drug therapy should be considered if LDL-C levels remain \uf0b3130 mg/dL (3.4 mmol/L), after 3 months of TLC. In patients at moderate risk (\uf0b32 risk factors and 10-year CHD risk of <10%) the guidelines recommend that TLC are initiated at LDL-C levels of \uf0b3130 mg/dL (3.4 mmol/L), with the aim of <130 mg/dL (3.4 mmol/L). In this group drug therapy should be considered at LDL-C levels \uf0b3160 mg/dL (4.1 mmol/L). In individuals at lower risk (<2 risk factors) and whose LDL-C levels are \uf0b3160 mg/dL (4.1 mmol/L), TLC are recommended. Drug therapy should be considered when LDL-C levels are \uf0b3190 mg/dL (5 mmol/L) despite TLC, and is optional depending on clinical judgement at LDL-C levels of 160\u2013189 mg/dL (4.1-5 mmol/L). The goal for LDL-C in this risk category is <160 mg/dL (4.1 mmol/L). When LDL-C lowering drug therapy is employed in high-risk or moderately high-risk patients, it is advised that intensity of therapy be sufficient to achieve at least a 30% to 40% reduction in LDL-C levels. Moreover, any person at high risk or moderately high risk who has life-style related risk factors (eg obesity, physical inactivity, elevated TG, low HDL-C or the metabolic syndrome) is a candidate for TLC to modify these risk factors regardless of LDL-C level. Reference. 1. Grundy SM, Cleeman JI, Merz NB et al. Circulation 2004;110:227\u2013239. Existing LDL-C goals. Proposed LDL-C goals.  Therapeutic option. 70 mg/dL =1.8 mmol/L; 100 mg/dL = 2.6 mmol/L; 130 mg/dL = 3.4 mmol/L; 160 mg/dL = 4.1 mmol/L. Grundy SM et al. Circulation 2004;110:", "Image XResolution": "37", "Image YResolution": "37", "Image ResolutionUnit": "Pixels/Centimeter", "Image Software": "SlidePlayer", "Image YCbCrPositioning": "Centered"}