National Cholesterol Education Program Adult Treatment Panel III guidelines and obesity: implications for Canada

The National Cholesterol Education Program Adult Treatment Panel (ATP) III recommendations incorporate new evidence for treating elevated low-density lipoprotein cholesterol.

Comparisons between the prevalence of drug-eligible Canadians under the old ATP II and the new ATP III guidelines were made, and the impact of obesity on current and future drug eligibility was explored using various models.

Participants from the Canadian Heart Health Surveys (1986 to 1992; n=17,728; 20 to 74 years of age) were assigned to therapeutic lifestyle change or drug-eligible groups in the event of elevated low-density lipoprotein cholesterol. Body mass index was used to classify participants as having normal weight, or as being overweight or obese. The prevalence of overweight and obese status for 2001, 2006 and 2011 were projected from past trends by linear regression. Population attributable risk was used to model reductions or increases in the prevalence of obesity in drug-eligible participants using several nationally representative population health surveys.

In 2001, an additional 1.1 million Canadians were drug-eligible under ATP III (16.0% of men, 9.5% of women), compared with ATP II (7.7% of men, 7.7% of women). Drug eligibility was elevated in overweight participants (men: OR=1.87 [1.51 to 2.31]; women: OR=1.60 [1.13 to 2.28]) and the obese (men: OR=2.86 [1.86 to 4.38]; women: OR=2.28 [1.63 to 3.18]) versus normal weight participants. The population attributable risk was higher in men (overweight 22.6%, obese 11.5%) than in women (overweight 9.4%, obese 9.2%).

A 10% reduction in overweight and obesity prevalence could have prevented 69,530 cases of drug eligibility in 2001. On the other hand, by 2011 over one million Canadians will be drug-eligible because of an elevated body mass index, if the recent trends in overweight and obese status continue.