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Clinical significance of plasma lipid levels
1National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892.
Insights
High LDL cholesterol and low HDL cholesterol are key risk factors for coronary artery disease (CAD). Reducing LDL cholesterol significantly lowers CAD incidence and risk, guiding treatment goals.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Preventive Cardiology
Background:
- Elevated low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol are established risk factors for coronary artery disease (CAD).
- Clinical trials demonstrate that lowering LDL cholesterol reduces CAD incidence and risk.
- The National Cholesterol Education Program provides guidelines for adult plasma cholesterol evaluation.
Purpose of the Study:
- To outline the National Cholesterol Education Program guidelines for plasma cholesterol evaluation in adults.
- To define blood cholesterol classifications and risk factor assessment for therapeutic intervention decisions.
- To establish LDL cholesterol as the primary target for hyperlipidemia treatment goals.
Main Methods:
- Classification of blood cholesterol levels: desirable (<200 mg/dl), moderate-high (200–239 mg/dl), and high (≥240 mg/dl).
- Consideration of lipoprotein risk factors (e.g., low HDL, elevated lipoprotein (a)) and nonlipid factors (e.g., age, hypertension, smoking, diabetes) for intervention decisions.
- Lipoprotein analysis recommended for individuals with borderline-high or high cholesterol, especially with existing CAD or other risk factors.
Main Results:
- LDL cholesterol is the primary lipoprotein for determining treatment goals in hyperlipidemia.
- Dietary therapy is the initial management for patients with LDL cholesterol >160 mg/dl (without CAD or 2 other risk factors) or >130 mg/dl (with CAD or 2 other risk factors).
Conclusions:
- The primary goal of hyperlipidemia treatment is to reduce LDL cholesterol levels.
- Target LDL cholesterol levels are <160 mg/dl, or <130 mg/dl for patients with established CAD or multiple risk factors.
Abstract:
Epidemiologic studies have established that elevated low-density lipoprotein (LDL) cholesterol values and decreased levels of high-density lipoprotein (HDL) cholesterol are risk factors for coronary artery disease (CAD). Results from clinical trials indicate that reduction in LDL cholesterol decreases the incidence of and reduces the risk of CAD. The National Cholesterol Education Program recently developed guidelines for the evaluation of plasma cholesterol in adults. Initial classification is categorized and based on the following values: less than 200 mg/dl is "desirable" blood cholesterol; from 200 through 239 mg/dl is classified as "moderate-high" blood cholesterol; and greater than or equal to 240 mg/dl is "high" blood cholesterol. Decision-making regarding therapeutic intervention is influenced by the presence of other lipoprotein risk factors, such as reduced HDL cholesterol and elevated lipoprotein (a), and nonlipid factors, including age, sex, hypertension, obesity, smoking, diabetes mellitus, and family or patient history of CAD. Persons with borderline-high blood cholesterol and established CAD or 2 other risk factors as well as those with high blood cholesterol should undergo lipoprotein analysis. LDL cholesterol is the primary lipoprotein to consider when determining treatment goals. Patients with LDL cholesterol levels greater than 160 mg/dl without CAD or 2 other risk factors and those patients with LDL cholesterol greater than 130 mg/dl with CAD or 2 other risk factors are initially managed with dietary therapy. The goal of treatment of hyperlipidemia is to reduce LDL cholesterol to less than 160 mg/dl or to less than 130 mg/dl in patients with established CAD or with 2 other risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)