New Cholesterol Guidelines

Since the full report of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) was published in 2002, new clinical evidence has suggested that - at least in high-risk and intermediate-risk patients - reducing LDL cholesterol to very low levels (i.e., to below 70 mg/dL instead of the currently recommended 100 -130 mg/dL) significantly reduces the risk of death and cardiovascular events.

In response, the NCEP commented on this new information, publishing an update on the ATP III guidelines in 2004. In general, the ATP III guidelines now recommend that LDL cholesterol levels be brought below 100 mg/dL in high-risk and moderate risk patients. This is substantially lower than the target levels of 130 mg/dL or below in the past.

Specifically, the new recommendations are:

For high-risk patients (those with a 10-year risk* of a cardiac event of 20%): The LDL cholesterol should be lowered to below 100 mg/dL, and consideration should be given to lowering it to below 70 mg/dL.

For moderately high-risk patients (those with a 10-year risk* of a cardiac event between 10 and 20%): LDL cholesterol should be lowered to below 130 mg/dL, and consideration should be given to lowering it to below 100 mg/dL.

For intermediate-risk patients (those with a 10-year risk* of a cardiac event less than 10%): LDL cholesterol should be lowered to below 130 mg/dL.

For low-risk patients (those with a 10-year risk* of a cardiac event less than 1%): LDL cholesterol should be below 160 mg/dL.

Most observers in the field have come out in strong support of these new recommendations, though there are some critics. On one hand, some critics argue that even the new recommendations are not strong enough in light of recent clinical trials, and that a target of 70 mg/dL or lower should be emphasized much more strongly. On the other hand, others (those fond of slamming the pharmaceutical industry) point out that many members of the NCDP ATP III panel have ties to the companies that make statin drugs, and that their recommendations are biased.

My own reading of the new data finds the evidence that there is benefit in reducing LDL cholesterol in high-risk patients to very low levels is compelling, and the 2004 revision to the ATP III guidelines are, if anything, conservative.

* You can find out how to assess your own 10-year risk of heart disease here.

_Sources:

_{Grundy SM, Cleeman JI, Bairey Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-239.}