RATIONALE FOR TREATMENT GUIDELINESMadhav Vissa

ATP III

Adult Treatment Panel Guidelines for tx of High Cholesterol Based on epidemiological

evidence about

risk factors for CHD

↑ Cholesterol ↑ CHD Risk

5 steps to determine risk

Step 1 – Lipid Profile Step 2 – CHD Equivalents

CHD is a risk factor for coronary events, other things are too.○ DM○ Symptomatic CAD○ Peripheral artery dz○ AAA○ Chronic Kidney Dz

More Steps

Step 3 – Other major Risk factors (not LDL)Smoking, HTN, Low HDL (<40), Fam Hx, Older

age Stage 4 – ≥2 risk factors +/- CHD Equivalent

• Based on Framingham risk tables – may overestimate risk in European and Asian Populations

• Do not need to do this in pt with 1 or fewer risk factors (10 year risk of CHD is <10%)

Step 5

“determine the risk category that establishes the LDL goal”More risk factors = lower LDL moreInitiate drug therapy if LDL cannot be

lowered to desired level with lifestyle changes

References

UpToDate - ATP III guidelines for treatment of high blood cholesterol