The National Cholesterol Education Program Adult Treatment Panel Iii—how Do Women Fit In?

The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) released initial guidelines in 1988 (ATP I), followed by ATP II in 1993 and ATP III in 2001. In ATP I and II, treatment recommendations and goals of therapy for secondary prevention are similar. However, ATP III established a more aggressive approach for both secondary prevention and higher risk primary-prevention patients and included the introduction of a new coronary heart disease (CHD) risk equivalent category, an in-depth discussion of the metabolic syndrome, the establishment of non-high density lipoprotein (HDL) goals, and use of the Framingham Heart Study risk projections to identify higher risk primary-prevention patients. Patients with CHD risk equivalents are to be treated as aggressively as those patients with established CHD. In ATP III, the presence of the metabolic syndrome—characterized by the lipid triad of elevated triglycerides, low HDL cholesterol, and small, dense, low-density lipoprotein (LDL) cholesterol—is associated with an increased risk of cardiovascular events and is a secondary target of therapy. Another secondary target of therapy is non-high-density lipoprotein cholesterol (non-HDL-C), the difference between total cholesterol and HDL-C. Graded risk factors based upon the Framingham Heart Study projections are included to estimate 10-year risk of CHD. Based upon the more stringent guidelines of ATP III, as compared to ATP II, a more aggressive treatment strategy is warranted in dyslipidemic patients. (Advanced Studies in Medicine 2001;2(11):409-415)