The National Cholesterol Education Program's (NCEP's) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults creates updated clinical guidelines for testing and management of cholesterol. NCEP periodically updates existing recommendations based on new research. The third version, Adult Treatment Panel III or ATPIII, was published in 2001. In 2004, updates were added based on several clinical trials of statin therapy.

The fact is, elevated low-density lipoprotein (LDL), the bad cholesterol, is a major cause of heart disease. LDL causes the build-up of fatty deposits within your arteries, reducing or blocking the flow of blood and oxygen your heart needs. This can lead to chest pain and heart attack. (Atherosclerosis, the medical term for "hardening of the arteries," is not limited to heart arteries, though. It also occurs in arteries elsewhere in your body, causing problems such as stroke, kidney failure and poor circulation.). In addition, studies show that lowering LDL cholesterol reduces risk for coronary heart disease. For this reason, ATPIII continues to focus goals of initiating treatment based on LDL.

It is extremely important for everyone -- men and women of every age, with or without known heart disease — to have a low LDL cholesterol level. The optimal guideline level of LDL cholesterol is less than 100 mg/dl. Research from the Cleveland Clinic (REVERSAL study) compared two cholesterol lowering drugs (pravastatin and atorvastatin) and found that lower levels of LDL, as low as 60 mg/dl had better outcomes. A second study called PROVE-IT also found that the lower the LDL cholesterol the better - the PROVE-IT study results stated - "These findings indicate that patients who have recently had an acute coronary syndrome benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels." TNT, Treating to New Targets also found that "intensive Atorvastatin therapy to achieve LDL cholesterol concentrations well below recommended target levels provides an incremental clinical benefit in patients with stable coronary artery disease." These studies have impacted LDL goals and have provided now options as to when to initiate drug therapy — as seen in the new updates.

Additional research has shown that statins, drugs used to treat high LDL cholesterol appear to also protect the heart in other ways. These drugs also reduce the progression of plaque buildup in the coronary arteries by reducing C-reactive protein, a measure of inflammation in the arteries. Therefore, it seems the lower the LDL cholesterol the better, and how you get there may be important as well.

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Reviewed: 12/2013

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