Stone NJ, Bilek S, Rosenbaum S. Recent National Cholesterol Education Program Adult Treatment Panel III update: Adjustments and options

Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
The American Journal of Cardiology (Impact Factor: 3.28). 08/2005; 96(4A):53E-59E. DOI: 10.1016/j.amjcard.2005.06.006
Source: PubMed


In the summer of 2004, an evidence-based update of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines for management of hypercholesterolemia was published. This detailed assessment of 5 major clinical trials, published since the ATP III report in 2001, was designed to provide guidance for physicians in decision making for patients at high risk and very high risk. We have tried to summarize this assessment by suggesting the following to clinicians: (1) Calculate global risk of coronary artery disease (CAD) to determine an overall strategy for cholesterol management. (2) Emphasize the benefits of diet, exercise, and weight control or therapeutic lifestyle change, especially in those with lifestyle risk factors. (3) Use 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors (statins) as first-line drugs to reduce risk of CAD and stroke in those at moderate to high risk. (4) If statins are prescribed, use moderate doses that reduce plasma levels of low-density lipoprotein (LDL) cholesterol by > or = 30% to 40%. (5) Strongly consider statin therapy in those with diabetes (with the exception of severe hypertriglyceridemia). (6) Consider LDL cholesterol-lowering drug therapy for lipids in older patients at risk. (7) Consider adding either a fibrate or nicotinic acid in high-risk patients with elevated plasma triglyceride values or low levels of plasma high-density lipoprotein cholesterol after statin therapy has achieved the LDL cholesterol goal. (8) Continue to treat those at low risk in similar fashion as before. This update is to inform current physician judgment in this area. Further clinical trial data that may modify or extend these recommendations are eagerly awaited.

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    • "This additional measurement three months after the first is enough to evaluate the maximum efficacy of statin treatment. The dose of simvastatin (10-40 mg/daily) or atorvastatin (10- 40 mg/daily) was adjusted if required, according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) treatment goal for LDL-C based on the risk category (LDL-C < 130 mg/dL, high-risk < 100 mg/dL or very high-risk < 70 mg/dL, which correspond to concentrations of < 3.4, < 2.6 and < 1.8 mmol/L, respectively) (Stone et al., 2005). The % decrease in LDL-C with statin treatment is usually predictable. "
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    ABSTRACT: In this work, we examined the impact of polymorphism in the cytochrome P450 (CYP) 3A5 gene, CYP3A5*1 (6986A > G, rs 776746), on the reduction in the lipid levels caused by simvastatin and atorvastatin. We studied 350 hyperlipidemic patients who received 10-40 mg of atorvastatin (n = 175) or simvastatin (n = 175) daily. Genotyping for CYP3A5 was done by PCR-RFLP analysis. Differences in the lipid profile before and after treatment were expressed as the % difference. The frequency of CYP3A5 polymorphism was 13.4% for heterozygotes and 86.6% for homozygotes. Comparison of the responses to same dose of each drug showed that the highest % difference was associated with total cholesterol (TC) in subjects receiving atorvastatin 40 mg compared with simvastatin 40 mg (p = 0.048). However, comparison of the responses to equivalent doses of atorvastatin vs. simvastatin revealed no difference in the % change in any of the lipid parameters examined. In individuals with the same CYP3A5 genotype, a head to head comparison of the efficacy of the same dose of simvastatin vs. atorvastatin revealed an advantage for atorvastatin. For equivalent doses of atorvastatin vs. simvastatin there was no difference in the % change in any of the lipid parameters examined. Within the same genotype there was a significant difference in the % change related to the drug treatment.
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    • "This observation is consistent with other studies (Freedman et al., 2004; Ai et al., 2010; Skoczyńska et al., 2013) as well as with National Cholesterol Education Program report, ATPIII: prior to the age of menopause, females have lower total cholesterol levels than males of the same age. After menopause, however, cholesterol levels tend to rise in women (Stone et al., 2005). "
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    ABSTRACT: The study was undertaken to evaluate the interest of cholesterol subclasses in the management of hypertensive patients recruited at University Hospital Yalgado Ouedraogo of Ouagadougou (Burkina Faso, West Africa). The distribution of hypertensive was reported as 45 (35.4%) without complications, 42 (33%) with cardiovascular complications and 40 (31.4%) with diabetes. Any difference in lipids profile was observed when balanced hypertensive was compared to non-balanced hypertensive. The total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and HDL3 cholesterol (HDL3C) were significantly higher in hypertensive compared to the control group (p<0.001). Significant decrease of TC and HDLC levels was observed in women within hypertensive group (p<0.05). The increase in triglyceride (TG) and low density lipoprotein cholesterol (LDLC) was significant in obese compared to non-obese. The HDLC level was higher (p<0.01) in treated hypertensive compared to untreated, particularly females. The HDLC increased significantly in treated hypertensive without complications (p<0.01). The TC and LDLC levels were higher in treated hypertensive with diabetes (p<0.05). The HDL2 cholesterol (HDL2C) was significantly lower in treated hypertensive with diabetes (p<0.05), and particularly in obese compared to non-obese. A significant decrease of HDL2C was observed in female stage 3 hypertensive (p<0.05). The HDL2C might be a better predictor of cardiovascular risks in hypertensive if the relationship between its decrease with severity of hypertension is confirmed by further studies.
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    • "). Dyslipidemia was defined as having one or more of the following parameters: total cholesterol (TC) !200 mg/dL, low density lipoprotein (LDL) !130 mg/dL, triglyceride (TG) !150 mg/dL, high density lipoprotein (HDL) <40 mg/dL or !60 mg/dL as per ATP III guidelines [14] "
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