Elevated LDL cholesterol is the major cause of coronary heart disease thus ATP III continues to identify elevated LDL as the primary target of cholesterollowering therapy. A asic principle of prevention is that the intensity of ris!-reduction therapy is adjusted ased on the person"s a solute ris!. #is! assessment is ased on measurement of the LDL cholesterol and identification of accompanying ris! determinant.
STEP T(O: ASSESS)ENT *OR PRESENCE O* IG RIS+ CORONAR, EART DISEASE E-.I/ALENTS
Identify 'resence of clinical at!erosclerotic disease t!at confers !i#! ris0 for coronary !eart disease "C D% e1ents "C D ris0 e2ui1alent%:
:linical :,D
;ymptomatic carotid artery disease Peripheral arterial disease A dominal aortic aneurysm Dia etes is considered a :,D ris! e<uivalent in ATP III
:igarette smo!ing ,ypertension )4P ?(9%2'% mm,g or on antihypertensive medication+ Low ,DL cholesterol )/9% mg2dL+@ Aamily history of premature :,D ):,D in male first degree relative /.. yearsB :,D in female first degree relative /5. years+ Age )men ?9. yearsB women ?.. years+
*HDL cholesterol 760 mg/dL counts as a negative risk factor; its presence removes one risk factor from the total count.
STEP *O.R: I* 4 OR )ORE )A3OR RIS+ *ACTORS OT ER T AN LDL ARE PRESENT T EN ASSESS 567,EAR C D RIS+
If $C ris! factors )other than LDL+ are present without :,D or :,D ris! e<uivalent* assess (%-year )short-term+ :,D ris! )see Aramingham ta les+. Three levels of (%-year ris! are>
A (% year ris! factor ?$%D means that $% out of (%% individuals will develop coronary heart disease or a coronary event within (% years.
Esta lishing LDL goal of therapy Determining need for therapeutic lifestyle changes )TL:+ Determining level for drug consideration
LDL C!olesterol Goals and Cutoff Points for T!era'eutic Lifestyle C!an#es "TLC% and Dru# T!era'y in Different Ris0 Cate#ories LDL level at which LDL level at which to consider drug #is! :ategory LDL -oal to initiate TL: therapy :,D or :,D #is! /(%% mg2dL7(%% mg2dL 7(3% mg2dL
E<uivalents )(% year ris! factor ?$%D+ $C #is! Aactors )(% year ris! factor /(3% mg2dL7(3% mg2dL F$%D+ %-( #is! Aactor /(5% mg2dL7(5% mg2dL
)(%%-($' mg2dL> drug optional+@ (%-year ris! (%-$%D> 7(3% mg2dL (%-year ris! /(%D> 7(5% mg2dL 7('% mg2dL )(5%-(6' mg2dL> LDL-lowering drug optional+
* !ome authorities recommend use of LDL"lo#ering drugs in this categor$ if an LDL cholesterol %&00 mg/dL cannot 'e achieved '$ therapeutic lifest$le changes. (thers prefer use of drugs that primaril$ modif$ trigl$cerides and HDL) e.g.) nicotinic acid or fi'rate. *linical +udgment also ma$ call for deferring drug therap$ in this su'categor$. ,lmost all people #ith 0"& risk factor have a &0"$ear risk %&0-) thus &0"$ear risk assessment in people #ith 0"& risk factor is not necessar$.