New guidelines for managing hypercholesterolemia.
OBJECTIVE
To summarize for pharmacists the Adult Treatment Panel III (ATP III), recently issued guidelines for managing hypercholesterolemia, from the National Cholesterol Education Program (NCEP).


METHODS
Executive summary of ATP III, and other pertinent literature as determined by the author.


METHODS
Not applicable.


METHODS
By the author.


RESULTS
Like previous guidelines issued by NCEP, ATP III focuses on lowering of low-density lipoprotein cholesterol (LDL-C) as a primary focus and using exercise, diet, and pharmacotherapy as a primary means of lowering patients' coronary heart disease (CHD) risks. The new guidelines recognize LDL-C levels of less than 100 mg/dL as optimal for all patients, and increase attention on high triglyceride levels (above 200 mg/dL). ATP III places more emphasis on identifying patients at risk for CHD and CHD events (e.g., myocardial infarctions, revascularization procedures). To apply the recommendations of ATP III in pharmaceutical care practice, pharmacists should follow a six-step process: (1) Assess the patient's lipid profile (full panel, not just total cholesterol); (2) assess and categorize the patient's CHD risk (using a point system reflecting the levels of risk inherent in certain factors); (3) establish treatment goals and approaches (the greater the risk, the more aggressive the management); (4) initiate therapeutic lifestyle changes (including new recommendations for low intake of saturated fats and dietary cholesterol); (5) initiate LDL-C lowering drug therapy (often with combination therapy); and (6) consider other lipid factors (particularly hypertriglyceridemia and the metabolic syndrome).


CONCLUSIONS
Most patients who begin lipid-lowering therapy stop it within 1 year, and only about one-third of patients reach treatment goals. The release of the ATP III guidelines provides pharmacists a great opportunity to enhance pharmaceutical care services directed specifically at patients with hyperlipidemia.
McKenney
J M
JM
School of Pharmacy, Medical College of Virginia, Virginia Commonwealth University, and National Clinical Research, Richmond 23294, USA. jmckenney@ncrinc.net
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000209:etiology / Q000628:therapy; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects
D000924:Anticholesteremic Agents