For the first time since 1993, the National Cholesterol Education Program (NCEP) has issued updated clinical guidelines for the testing and management of high cholesterol among adults. The NCEP is coordinated by the National Heart, Lung, and Blood Institute (NHLBI), which is part of the U.S. government’s National Institutes of Health. These revised guidelines constitute the Third Report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).

Revisions were based on evidence from recent clinical trials. A major change from the previous guidelines is an increased focus on primary prevention among people with more than one risk factor for coronary heart disease (CHD). In particular, studies have shown that people at high risk for CHD should have more aggressive treatment to lower their levels of low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol) than was previously recommended. LDL cholesterol is clearly stated in the guidelines as the primary target of cholesterol-reducing therapy.

Other changes from the earlier guidelines include:

• more aggressive treatment of high cholesterol among diabetics;
• a new method for determining an individual’s risk of developing CHD;
• use of a complete lipoprotein profile as the first test for high cholesterol, which health adults should have done every 5 years;
• a new level at which low high-density lipoprotein (HDL) cholesterol becomes a major risk factor for heart disease;
• a new treatment plan – “therapeutic lifestyle changes (TLC)” – that enhances use of nutrition, exercise, and weight control for prevention of CHD;
• increased focus on individuals with an array of major heart disease risk factors – a condition called “the metabolic syndrome” – as a secondary target of risk reduction therapy;
• increased focus on the treatment of individuals with high triglycerides found to be risk factors for CHD; and
• the recommendation of cholesterol-lowering drugs rather than hormone replacement therapy to reduce the risk of CHD among postmenopausal women.

A likely outcome of the new guidelines is an increase in the number of people being treated for high cholesterol. Evidence strongly supports that such aggressive treatment to lower cholesterol can significantly reduce the risk of heart disease.

The panel notes that these guidelines should be used to guide clinical practice; however, treatment should still be based on doctors’ clinical judgment of what is appropriate for each of their patients.