New recommendations for the diagnosis and treatment of plasma lipid abnormalities

Abstract

Elevated total blood cholesterol levels (at or above 240 mg/dL) due to increased low density lipoprotein (LDL) cholesterol values (at or above 160 mg/dL) have been associated with an increased risk of coronary heart disease (CHD). It has been shown in controlled prospective studies that when LDL cholesterol is lowered with diet or diet and drug treatment, subsequent risk of CHD morbidity and, in some cases, mortality can be reduced. New guidelines have recently been released by the Adult Treatment Panel (ATP II) of the National Cholesterol Education Program (NCEP). Risk factors for CHD in addition to elevated LDL cholesterol now include: 1) male 45 years or older; 2) female 55 or older, or with premature menopause and not on estrogen replacement; 3) high density lipoprotein (HDL) cholesterol less than 35 mg/dL; 4) hypertension; 5) cigarette smoking; 6) diabetes mellitus; and 7) a family history of premature CHD. After screening with total cholesterol and HDL cholesterol measurements, patients with total cholesterol values at or above 200 mg/dL, HDL cholesterol below 35 mg/dL, and/or CHD should have a fasting cholesterol, triglyceride, and HDL cholesterol measurement. Candidates for diet therapy are those with LDL cholesterol values at or above 1) 160 mg/dL; 2) 130 mg/dL in the presence of two or more CHD risk factors; or 3) 100 mg/dL in the presence of CHD. Candidates for drug therapy after diet treatment are those with LDL cholesterol values at or above 1) 190 mg/dL; 2) 160 mg/dL in the presence of two or more CHD risk factors; or 3) 130 mg/dL in the presence of CHD.(ABSTRACT TRUNCATED AT 250 WORDS)