title: The place of HDL in cholesterol management. A perspective from the National Cholesterol Educational Program.
abstract: The guidelines developed by the Adult Treatment Panel of the National Cholesterol Education Program identified low density lipoprotein (LDL) as the major atherogenic lipoprotein, and high levels of LDL-cholesterol as the primary target for cholesterol-lowering therapy. Low levels of high density lipoprotein (HDL)-cholesterol were recognized as a major risk factor for coronary heart disease. This report reexamines in depth the recommendations of the Adult Treatment Panel on HDL-cholesterol. Two major questions are discussed: (1) Should HDL-cholesterol levels be measured in all adults, as recommended for total cholesterol? (2) Should patients found to have a low serum HDL [corrected]-cholesterol level (less than 35 mg/dL [less than 0.91 mmol/L]) enter medical therapy to raise the level? The guidelines of the Adult Treatment Panel are reaffirmed as appropriate from the current perspective. These guidelines recommend that HDL-cholesterol levels be determined in patients deemed to be at high risk for coronary heart disease and suggest that HDL measurement is optional for individuals with borderline-high total levels. The guidelines of the Adult Treatment Panel recommend that low HDL-cholesterol levels be raised mainly by hygienic means (ie, smoking cessation, weight loss, aerobic exercise). When drug therapy is required for high LDL-cholesterol levels in the presence of low HDL levels, cholesterol-lowering drugs that concomitantly raise HDL should be given first priority.
authors.affiliation: National Cholesterol Education Program, National Heart, Lung, and Blood Institute, Bethesda, Md.
authors.forename: S M
authors.initials: SM
authors.lastname: Grundy
authors.forename: D W
authors.initials: DW
authors.lastname: Goodman
authors.forename: B M
authors.initials: BM
authors.lastname: Rifkind
authors.forename: J I
authors.initials: JI
authors.lastname: Cleeman
mesh_terms: D002791:Cholesterol, Dietary / Q000008:administration & dosage*; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000517:prevention & control*; D006801:Humans; D008403:Mass Screening; D012307:Risk Factors; D014481:United States
chemical_list: D002791:Cholesterol, Dietary; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL