Practice Guideline - Adult Cholesterol Management
ATP III(1) and subsequent studies have greatly expanded the
recommendations for Cholesterol lowering therapy. Physicians should
aggressively treat high cholesterol especially in patients with heart
disease or diabetes. MCI endorses the following 2004 recommendations of the
NCEP(2) as summarized in the following table:
| Risk Category | LDL-C Goal | Lifestyle Changes | Consider Drug Therapy |
High risk:
CHD or CHD risk equivalent*
(10 yr. risk > 20%) | <100 mg/dl
(optional < 70 for very high risk**) | LDL >100 mg/dl |
LDL >100 mg/dl
(optional for <100) |
Moderately high risk:
2+ risk factors
(10 yr. Risk 10% - 20%) |
<130 mg/dl |
LDL >130 mg/dl |
LDL >130 mg/dl
(optional for 100-129) |
Moderate risk:
2+ risk factors
(10 yr. Risk < 10%) |
<130 mg/dl |
LDL >130 mg/dl |
LDL >160 mg/dl |
Lower risk:
0-1 risk factors |
<160 mg/dl |
LDL >160 mg/dl |
LDL >190 mg/dl
(optional for 160-190) |
* CHD risk equivalents include: Non-coronary ASVD,
Diabetes, and 2+ risk factors with >20% 10 yr. Risk.
** Very high risk includes: established CHD plus one of the following:
1. Diabetes, 2. continued smoking, 3. High triglycerides plus
low HDL-C.
To achieve these goals MCI recommends:
- Calculate the 10 year absolute risk of CHD for patients
with 2 or more risk factors
- Smoking
- Hypertension (BP> 140/90 or on HTN medication)
- Low HDL-C < 40mg/dl
- Age (men >45, women >55)
- Family History of premature CHD (male first degree
relative <55 or female < 65)
- Therapeutic Lifestyle Changes with patient generated goals
- Diet: reduce intakes of saturated fat (<7% of calories) and
cholesterol (<200 mg/day), Referral to a registered dietician is
encouraged/p>
- Weight reduction
- Increased physical activity
- Goal of drug therapy is to reduce LDL-C by 30%-40%
- Patients on Lipid lowering drugs should be
considered for Aspirin therapy
- Assess Medication
Adherence in patients
not meeting goals by
asking:
- “Many patients forget
to take medications, in
the last week how often
have you forgotten to
take your medication?”
- Follow-up every 3-6
months
References:
- Detection, Evaluation,
and Treatment of High
Blood Cholesterol in
Adults (Adult Treatment
Panel III); NIH
Publication No. 01-3670;
May 2001
- Implication of Recent
Clinical Trials for the
National Cholesterol
Education Program Adult Treatment Panel
III Guidelines
(Circulation. 2004;
110:227-239)
Variation from this
guideline is always
acceptable, if in the
opinion of the attending
physician, individual
circumstances require
it.
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