New National Cholesterol Education Program III guidelines for primary prevention lipid-lowering drug therapy: projected impact on the size, sex, and age distribution of the treatment-eligible population

Abstract

Background: The guidelines in the Third Report of the National Cholesterol Education Program (NCEP III) include absolute risk and lower LDL cholesterol (LDL-C) levels to assess eligibility for lipid-lowering drug therapy. We studied the impact of these changes on the size, sex, and age distribution of the target US population using data from the Third Annual National Health and Nutrition Survey (NHANES III) (1988 to 1994).

Methods and results: A subsample of NHANES III participants aged 20 to 79 years with known cardiovascular risk factors and LDL-C levels was identified (n=13 589). We assessed their eligibility for drug therapy first using NCEP II guidelines and then using the new NCEP III criteria. We also calculated the number eligible for LDL-C lowering to <100 mg/dL. An estimated 15 million individuals aged 20 to 79 years are eligible for drug therapy under NCEP II; 51% are males, 49% are females, 26% are <45 years old, and 28% are > or =65 years old. Under NCEP III, 36 million would be eligible for treatment; 55% are males, 45% are females, 32% are <45 years old, and 27% are > or =65 years old. This represents a 140% increase in eligibility overall, a 157% increase among males, a 122% increase among females, a 131% increase among those > or =65 years old, and a 201% increase among those < 45 years old. Of treatment-eligible individuals, 26% of males, 24% of females, 39% of elderly, and 14% of those <45 years old are targeted for LDL-C lowering to <100 mg/dL.

Conclusions: The NCEP III guidelines will alter the age and sex distributions of the treatment-eligible population, targeting many more younger (<45 years old) and greater numbers of elderly (> or =65 years) individuals, particularly for aggressive intervention.