Revised cholesterol treatment guidelines

The National Cholesterol Education Program made several changes to its adult treatment panel report on the detection, evaluation and treatment of high blood cholesterol.

The revised guidelines recommend that physicians increase emphasis on coronary heart disease risk status as the guide to the type and intensity of cholesterol-lowering therapy. Patients with evident coronary heart disease are at highest risk and a therapeutic goal of low-density lipoproteins of less than 100 mg/dL is recommended. Age (45 years or older for men, and 55 years or older for women) was added to the list of major risk factors.

The guidelines recommend that physicians delay the use of drug therapy in most young men 35 years and younger and in pre-menopausal women with moderately high low-density lipoproteins (160 mg/dL to 220 mg/dL) who are otherwise at low risk for coronary heart disease. However, the guidelines encourage physicians to consider high-risk, post-menopausal women and high-risk elderly with high blood cholesterol as candidates for drug therapy.

The guidelines also urge physicians to pay more attention to low high-density lipoprotein levels as coronary heart disease risk factors. Physicians should add high-density lipoprotein levels to initial cholesterol-screening tests and evaluate them when selecting drug therapy. The guidelines designate a high high-density lipoprotein level as a factor that reduces the risk of coronary heart disease.