Coronary heart disease (CHD) is the leading cause of death in the United States and in most of the developed world, accounting for more deaths than all forms of cancer combined. Numerous major studies have confirmed earlier reports that lowering elevated LDL-C levels reduces the risk of CHD. The NCEP provided 3 sets of guidelines for treating elevated blood cholesterol levels in adults: Adult Treatment Panel (ATP) I, II, and III. ATP I proposed a strategy for primary prevention of CHD in persons with high levels of LDL-C (≥160 mg/dL) or with borderline high levels of LDL-C (130–159 mg/dL) and multiple (at least 2) risk factors (discussed in the section Risk Assessment). ATP II added intensive management of LDL-C in persons with established CHD. The ATP III guidelines recommended total cholesterol levels of less than 200 mg/dL, LDL cholesterol levels of less than 100 mg/dL, HDL cholesterol levels that are greater than or equal to 60 mg/dL (for HDL, more is better), and triglyceride levels of less than 150 mg/dL.
In 2013, a series of reports published in the United States questioned the value of having specific targets for LDL-C levels. These reports instead recommended the individual assessment of each patient’s cardiovascular risk, followed by aggressive treatment with statin drugs in those most likely to benefit. These recommendations are discussed later in this chapter.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.