Management of Dyslipidemia: Implications of the Adult Treatment Panel (atp) Iii Recommendations

The emphasis in managing dyslipidemia should be given to achieving and maintaining lipid goals in order to optimally reduce the risk of coronary heart disease (CHD). The recently released guidelines of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) are reviewed in this article. The guidelines renew the emphasis on low-density lipoprotein cholesterol (LDL-C) as the primary target of therapy, and indicate an optimal LDL-C for all patients is less than 100 mg/dL. Most patients with dyslipidemia will require drug therapy to achieve this and other lipidtreatment goals. Currently, only a minority of patients, including those with established CHD, is achieving treatment goals. Use of appropriate doses of drugs and drug combinations may enhance the likelihood of achieving target lipid levels. ATP III continues to emphasize the importance of therapeutic lifestyle changes, particularly dietary intervention. (Advanced Studies in Medicine 2001;1(5):188–196) H istorically, the term “control” has been used to describe efforts to manage hypercholesterolemia and other abnormalities of serum lipid levels. In recent years, the more specific phrase, “treat to goal,” increasingly has displaced the more general term, “control,” as the preferred terminology in discussions related to management of dyslipidemia. The semantic transition reflects growing recognition of the need to achieve and maintain lipid levels that are associated with reduced cardiovascular risk. The most widely recognized goals for lipid levels are included in the clinical guidelines of the US National Cholesterol Education Program (NCEP). In May 2001, the NCEP released updated findings and recommendations regarding the scope of dyslipidemia and clinical strategies to treat lipid disorders. The updated guidelines retain many of the basic principles of past versions, including the traditional lipid-level goals and the emphasis on low-density lipoprotein cholesterol (LDL-C) as the primary target of therapy. The new guidelines have some notable changes, such as increased emphasis on use of lipid-lowering drug therapy in a larger number of patients, and recognition of certain high-risk patient categories that warrant a more aggressive approach to therapy. While retaining a traditional focus on intensive treatment in the setting of secondary prevention, the new guidelines place unprecedented emphasis on primary prevention. In keeping with previous versions, the new NCEP guidelines offer a variety of pharmacologic and nonpharmacologic methods for achieving lipid goals. While this wide array of tools for treating dyslipidemia is available REVIEW ARTICLE