Cholesterol education implications for clinical practice

It is well established that an elevated plasma cholesterol level is a major risk factor for coronary heart disease (CHD). Furthermore, results from several clinical trials indicate that therapeutic reduction of high-risk plasma cholesterol levels is followed by a reduction in CHD risk. The National Cholesterol Education Program (NCEP) was launched to enhance the detection of individuals with increased risk for CHD due to elevated plasma cholesterol levels, and to provide guidelines to clinicians for the detection, evaluation and treatment of these high-risk individuals. The key features of the NCEP are described and the guidelines for the detection, evaluation and treatment of high blood cholesterol in adults are summarized. Appropriate treatment of high-risk individuals includes reduction of elevated cholesterol levels and control of other cardiovascular risk factors. Diet therapy is the first step in control of elevated plasma cholesterol levels. In high-risk individuals who do not respond adequately to diet therapy, drug treatment should be considered. Clinical judgment must be used to individualize treatment in each patient. Better detection and control of elevated cholesterol levels and other cardiovascular risk factors should spare high-risk individuals from morbidity and mortality associated with premature CHD.