Sunday, September 6, 2009

What are the 2004 NCEP cholesterol treatment guidelines?

After reviewing these large randomized cholesterol-lowering trials, The National Cholesterol Education Program (NCEP) expert panel published their new recommendations. The new NCEP recommendations, presented in the June, 2004 issue of Circulation, are:
The report advised physicians to consider more intensive LDL cholesterol-lowering for people at very high, high, and moderately high risk for a heart attack. These options include setting lower treatment goals for LDL cholesterol and initiating cholesterol-lowering drug therapy at lower LDL thresholds, as compared to ATP III guidelines published in 2001. For example, for patients with a very high risk of heart attacks, the LDL cholesterol treatment goal remains at <100mg/dl, but the report advised doctors to consider the option of lowering the LDL cholesterol (usually using a statin plus lifestyle changes) to < 70 mg/dl. 
The report emphasized the importance of initiating therapeutic lifestyle changes (TLC) to modify lifestyle-related risk factors (obesity, physical inactivity, metabolic syndrome, high blood triglyceride levels and low HDL cholesterol levels). TLC Lifestyle changes have the potential to reduce heart attack and stroke risks through several mechanisms beyond the lowering of LDL cholesterol. 
When LDL-lowering medication is used for very high, high or moderately high risk patients, the report advises that the intensity of LDL-lowering drug therapy be sufficient to achieve at least a 30 to 40 percent reduction in LDL cholesterol levels. 
When a very high or high risk patient also has high blood triglyceride or low HDL cholesterol levels, doctors may consider combining nicotinic acid or a fibrate with a statin. Nicotinic acid and fibrates are more effective than statins in lowering triglycerides and increasing HDL. 
Age should not be a consideration since older persons also benefit from lowering LDL cholesterol. Thus, it is never too late or the patient too old to begin lifestyle changes and medications to lower LDL cholesterol. A word of caution is in order. Elderly patients are more likely to have liver and kidney dysfunction, and are also more likely to be on multiple medications some of which may interfere with the breakdown of cholesterol-lowering drugs such as statins. Thus lower dosing may be necessary to avoid adverse side effects

No comments:

Post a Comment