The new National Cholesterol Education Program guidelines: clinical challenges for more widespread therapy of lipids to treat and prevent coronary heart disease.

T HE RECENTLY published National Cholesterol Education Program (NCEP) III guidelines present many new clinical challenges to health care providers and their patients. These guidelines recommend stricter target lipid levels as well as a broader approach to risk assessment in an effort to reduce premature death and disability from coronary heart disease (CHD) and stroke. Many more patients, especially in primary prevention, are candidates to improve their lipid profiles under the new guidelines. It has been estimated that, as a direct result of the new NCEP III guidelines, the number of US adults eligible for lipid modification has increased from 52 million to 65 million for therapeutic lifestyle changes, including diet, and almost 3-fold, from about 13 million to 36 million, for drug therapy (Figure). This report identifies and characterizes the untreated patients who would benefit from lipid modification and summarizes the efficacy, safety, and cost profiles of the various statins, the class of drugs with the largest and most conclusive body of evidence to support their more widespread use.