Professional Documents
Culture Documents
Presentation Objectives
• State the major goals of the Adult Treatment
Panel (ATP) III Guidelines.
• Describe the new risk stratification process,
low density lipid (LDL) goals and the
Framingham assessment.
• State the major medications used to lower
cholesterol and their common side effects.
• Describe the management of low high
density lipids (HDL), elevated triglycerides
(TGs) and the metabolic syndrome.
National Cholesterol
Education Program (NCEP)
• Adult treatment Panel I (1988)
– primary prevention in those with high LDL
• Adult treatment panel II(1993)
– reaffirmed the above, plus emphasis on
intensive management of LDL in those
with established coronary heart disease
(CHD)
• Adult treatment panel III (2001)
New features of ATP III
160-189 High
HDL cholesterol
<40 Low
>60 High
Identify Conditions that confer high
risk for CHD (CHD risk equivalents)
• Clinical CHD
• Symptomatic carotid artery disease
• Peripheral arterial disease
• Abdominal aortic aneurysm
• Diabetes Mellitus
• Multiple risk factors that confer 10
year risk for CHD > 20%
Major Risk Factors
• Major risk factors other than LDL cholesterol
that modify LDL goals
– Cigarette smoking
– Hypertension ( with or without medication)
– Low HDL Cholesterol
– Family history of premature CHD (<55 M, <65F)
– Age (M>45, F>55)
• HDL cholesterol >60 removes one risk factor
from the total count
Categories of Risk that Modify
LDL Goals
Risk Category LDL Goal (mg/dl)
• Statins
• Fibrates
• Bile Acid Sequestrants
• Nicotinic Acid
The Statins
• HMG CoA reductase inhibitors
– Reduce LDL & triglycerides (TG) , raise HDL
• Side effects
– Gastrointestinal (GI), myopathy, elevated liver
enzymes
• Contraindications
– absolute - liver disease (acute or chronic)
– Relative - concomitant use of cyclosporine,
macrolides, various antifungals, cytochrome p-450
inhibitors.
Relative efficacy of Statins
10 7 8
6
5 2
NA
0
-5
-10 -11
-10 -14 -15
-15 -19 -24
-39 -24 -32
-20 -38
-25
-30
-35
-40
Atorvastatin 10 Fluvastatin 40 Lovastatin 20 Pravastatin 20 Simvastatin 20
– Often genetic
– Important to screen for in early adulthood
– Need to screen families
– May require combined drug therapy.
Management of Specific
Conditions
• 2. Low HDL Cholesterol
• <150 normal
• 150-199 borderline high
• 200-499 high
• >500 very high
Management of specific
conditions
• Treatment of elevated triglycerides:
– when TGS > 500 then need to lower triglycerides
first to prevent pancreatitis.