Waiting for the National Cholesterol Education Program Adult Treatment Panel IV Guidelines, and in the Meantime, Some Challenges and Recommendations
ABSTRACT The National Cholesterol Education Program Adult Treatment Panel (ATP) has provided education and guidance for decades on the management of hypercholesterolemia. Its third report (ATP III) was published 10 years ago, with a white paper update in 2004. There is a need for translation of more recent evidence into a revised guideline. To help address the significant challenges facing the ATP IV writing group, this statement aims to provide balanced recommendations that build on ATP III. The authors aim for simplicity to increase the likelihood of implementation in clinical practice. To move from ATP III to ATP IV, the authors recommend the following: (1) assess risk more accurately, (2) simplify the starting algorithm, (3) prioritize statin therapy, (4) relax the follow-up interval for repeat lipid testing, (5) designate <70 mg/dl as an "ideal" low-density lipoprotein cholesterol target, (6) endorse targets beyond low-density lipoprotein cholesterol, (7) refine therapeutic target levels to the equivalent population percentile, (8) remove misleading descriptors such as "borderline high," and (9) make lifestyle messages simpler. In conclusion, the solutions offered in this statement represent ways to translate the totality of published reports into enhanced hyperlipidemia guidelines to better combat the devastating impact of hyperlipidemia on cardiovascular health.
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ABSTRACT: CHD morbidity and mortality rates have more than halved since their peak in the 1960s and 1970s. This trend is a result of many factors; however, primary prevention provides the bulk of this benefit. Despite this tremendous progress, cardiovascular disease remains the major cause of death and this trend is projected to persist given the continuous growth in those aged 65 years or greater. Although statin therapy has been a main contributor to a primary prevention strategy, there is still controversy about exposing a large healthy population to long-term statin therapy. Advocates contend the mortality benefits from an aggressive statin approach would remove heart disease from its perch as the greatest killer of Americans and stroke mortality would drop from third to fifth place. Those advocating a much more conservative approach contend the data are not available to expose a healthy population to lifelong statin therapy given limited data on mortality, potential adverse events, and considerable costs. Given these opposing views, this summary of the evolution of statin therapy for the primary prevention of cardiovascular disease will review the major factors fueling this debate.Current Atherosclerosis Reports 02/2013; 15(2):298. DOI:10.1007/s11883-012-0298-0 · 3.06 Impact Factor
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ABSTRACT: The purpose of this case series was to describe immediate changes to weight and lipid profiles after a 21-day Standard Process whole food supplement and dietary modification program. Changes in weight and lipid profiles were measured for 7 participants (6 men and 1 woman) participating in a 21-day program. The dietary modifications throughout the Standard Process program were consumption of (1) unlimited fresh or frozen vegetables and fruits and preferably twice as many vegetables as fruits, (2) ½ to 1 cup of cooked lentils or brown rice each day, (3) 4 to 7 teaspoons of cold pressed oils per day, and (4) at least 64 oz of water a day. After day 10 of the program, participants were allowed to consume 1 to 2 servings of baked, broiled, or braised poultry or fish per day. Participants consumed a whey protein-based shake as meal replacement 2 times per day. Nutritional supplementation included a cleanse product on days 1 to 7, soluble fiber supplementation including oat bran concentrate and apple pectin on all days, and "green food" supplementation on days 8 to 21. Weight loss ranged between 5.2 (2.4 kg) and 19.9 lb (9.0 kg) (average, 11.7 lb; 5.3 kg). Total cholesterol levels decreased with ranges between 11 and 77 mg/dL, and low-density lipoprotein cholesterol levels decreased in a range between 7 and 67 mg/dL. After participating in a dietary program, the 7 participants demonstrated short-term weight loss and improvements in their lipid profiles.Journal of chiropractic medicine 03/2013; 12(1):30-8. DOI:10.1016/j.jcm.2012.11.004
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ABSTRACT: The purpose of this study was to describe changes in anthropometric measurements, body composition, blood pressure, lipid profile, and testosterone following a low-energy-density dietary intervention plus regimented supplementation program. The study design was a pre-post intervention design without a control group. Normal participants were recruited from the faculty, staff, students, and community members from a chiropractic college to participate in a 21-day weight loss program. All participants (n = 49; 36 women, 13 men; 31 ± 10.3 years of age) received freshly prepared mostly vegan meals (breakfast, lunch, and dinner) that included 1200 to 1400 daily calories (5020.8 to 5857.6 J) for the women and 1600 to 1800 (6694.4 to 7531.2 J) daily calories for the men. Nutritional supplements containing enzymes that were intended to facilitate digestion, reduce cholesterol levels, increase metabolic rate, and mediate inflammatory processes were consumed 30 minutes before each meal. The regimented supplementation program included once-daily supplementation with a green drink that contained alfalfa, wheatgrass, apple cider vinegar, and fulvic acid throughout the study period. A cleanse supplementation containing magnesium, chia, flaxseed, lemon, camu camu, cat's claw, bentonite clay, tumeric, pau d'arco, chanca piedra, stevia, zeolite clay, slippery elm, garlic, ginger, peppermint, aloe, citrus bioflavonoids, and fulvic acid was added before each meal during week 2. During week 3, the cleanse supplementation was replaced with probiotic and prebiotic supplementation. Multiple paired t tests detected clinically meaningful reductions in weight (- 8.7 ± 5.54 lb) (- 3.9 ± 2.5 kg), total cholesterol (- 30.0 ± 29.77 mg/dL), and low-density lipoprotein cholesterol (- 21.0 ± 25.20 mg/dL) (P < .05). There was a pre-post intervention increase in testosterone for men (111.0 ± 121.13 ng/dL, P < .05). Weight loss and improvements in total cholesterol and low-density lipoprotein cholesterol levels occurred after a low-energy-density dietary intervention plus regimented supplementation program.Journal of chiropractic medicine 03/2013; 12(1):3-14. DOI:10.1016/j.jcm.2012.11.003