Practical application of Adult Treatment Panel III guidelines: three illustrative case histories

The Adult Treatment Panel III (ATP III) guidelines continue to emphasize intensive treatment for persons at risk for coronary heart disease (CHD). The newest feature is a focus on primary prevention in persons with multiple risk factors; the updated guidelines recognize diabetes as a CHD risk equivalent. These groups of people already are at high risk and can benefit from increased intensive treatment to lower serum low-density lipoprotein cholesterol (LDL-C) levels. The ATP III guidelines establish lower targets for LDL-C and triglyceride levels and higher targets for the high-density lipoprotein cholesterol level. The guidelines also combine several risk factors to estimate the probability of CHD with use of the Framingham risk point-scoring formula and emphasize the multifactorial benefits of drug therapy as an adjunct to lifestyle changes.