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Metabolic syndrome emerging
Title: Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III)
Address: Bethesda, Maryland
Source: JAMA 285:2486-2497 (May) 2001
Summary: New clinical practice guidelines for the prevention and management of elevated cholesterol in adults emphasize primary prevention of coronary heart disease in persons with multiple risk factors and early and aggressive lipid-lowering therapy for those at highest risk. Further guidelines suggest use of a lipoprotein profile as the first test for high cholesterol; a new level at which low HDL becomes a major risk factor for coronary heart disease (CHD) (<40 mg/dL); a new set of therapeutic lifestyle changes; more intense focus on the metabolic syndrome; and increased attention to treating high triglycerides. The Adult Treatment Panel (ATP) III also recommends that patients with diabetes be treated as intensively as those with heart disease, since diabetes confers a high risk of new CHD within 10 years and diabetic patients who experience myocardial infarction have an unusually high death rate. The new guidelines include a risk assessment tool that allows clinicians to translate clinical conditions and lifestyle factors into a single category of 10-year risk. A recommended lifestyle approach includes: reduced intake of saturated fats and cholesterol; use of foods that contain plant stanols and sterols or are rich in soluble fiber; weight reduction; and increased physical activity. For primary prevention, the first priority of drug therapy is achieving LDL goals; the usual drug will be a statin, but alternatives include a bile acid sequestrant or nicotinic acid. If monotherapy does not achieve target levels, LDL-lowering therapy can be intensified, either by increasing the statin dose or by combining a statin with a bile acid sequestrant or nicotinic acid. The LDL cholesterol primary target of therapy are (mg/dL): <100 - optimal; 100-129 -near optimal/above optimal; 130-159 borderline high; 160-189 - high; and >190 - very high. Total cholesterol (mg/dL): <200 - desirable; 200-239 borderline high; and >240 - high. HDL cholesterol (mg/dL): <40 - low; and >60 high. The use of hormone replacement therapy as an alternative to cholesterol-lowering drugs in postmenopausal women is not recommended. Intensive treatment of patients with CHD should be maintained with a new focus on prevention of CHD in persons with multiple risk factors.