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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