Role of the National Cholesterol Education Program Adult treatment panel III guidelines in managing dyslipidemia.

Using recently updated guidelines to evaluate and manage lipid disorders is discussed. Coronary heart disease (CHD) is a costly chronic condition associated with significant morbidity and mortality. Epidemiologic data further indicate that dyslipidemia and associated conditions, which may lead to CHD, are grossly undertreated. In 2001, the third National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) released updated guidelines for the evaluation and treatment of lipid disorders. Significant changes to the updated guidelines include designation of a CHD risk equivalent category identifying patients who require aggressive management, recommendation of Framingham-based CHD risk assessment in patients with multiple risk factors, revised target levels for several of the lipids and lipoproteins, and criteria for the identification of patients with the metabolic syndrome. Low-density lipoprotein cholesterol (LDL-C) continues to be the primary target of therapy. In addition, non-high-density lipoprotein cholesterol (HDL-C) is now defined as a secondary treatment target in patients with hypertriglyceridemia. Increased emphasis is placed on the metabolic syndrome, low HDL-C levels, and the presence of multiple and emerging risk factors in guiding the intensity of therapy. The NCEP ATP III guidelines acknowledge challenges in implementing and maintaining patient adherence to both lifestyle changes and pharmacotherapy regimens and provide strategies for increasing treatment success. Implementation of these new guidelines will likely enhance identification, management, and treatment success rates among patients at risk for CHD in the United States.