Quantifying the effect of applying the NCEP ATP III criteria in a managed care population treated with statin therapy

Revised treatment goals suggested by the third report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) represent a challenge to both physicians and the health care industry. We sought to quantify the impact of these changes in a large managed care population being treated with statin therapy.

Using data collected from a retrospective chart review of 1,962 managed care enrollees who received statin drug therapy between February 2001 and August 2001, we quantified the low-density lipoprotein cholesterol (LDL-C) goals and goal attainment of this population according to both the NCEP ATP II and ATP III criteria and further identified independent predictors of ATP III goal attainment using multivariable logistic regression modeling.

Overall, 21.1% (n = 414) of statin patients moved to a more stringent LDL-C goal when ATP III criteria were applied over ATP II. Substituting ATP III criteria for ATP II criteria resulted in a 6.8% decrease in the percentage of participants who had their most recent LDL-C value below the suggested goal, from 59.8% under ATP II to 53.0% under ATP III. Persons with existing coronary heart disease, diabetes, obesity, and stroke or transient ischemic attack were all less likely to meet the suggested NCEP ATP III LDL-C goal.

Taking into account the revised risk stratification of the ATP III guidelines and the lack of LDL-C goal attainment in patients currently taking statins, there will be an increase in the number of statin patients who require dose or agent adjustment, combination therapy, or compliance counseling to achieve their lower LDL-C goal.