Dr. Lloyd-Jones has received honoraria from Pfizer for speaking and for being a member of an advisory board.
Implications of Changing National Cholesterol Education Program Goals for the Treatment and Control of Hypercholesterolemia
Article first published online: 22 DEC 2005
Journal of General Internal Medicine
Volume 21, Issue 2, pages 171–176, February 2006
How to Cite
Persell, S. D., Lloyd-Jones, D. M. and Baker, D. W. (2006), Implications of Changing National Cholesterol Education Program Goals for the Treatment and Control of Hypercholesterolemia. Journal of General Internal Medicine, 21: 171–176. doi: 10.1111/j.1525-1497.2006.00323.x
Presented in part at the Society of General Internal Medicine National Meeting, May 14, 2005.
- Issue published online: 8 MAR 2006
- Article first published online: 22 DEC 2005
- Manuscript received June 29, 2005 Initial editorial decision September 28, 2005 Final acceptance September 29, 2005
- cardiovascular diseases;
- practice guidelines;
- hydroxymethylglutaryl-CoA reductase inhibitors
BACKGROUND: Modifications to the National Cholesterol Education Program (NCEP) guidelines lowered optional low-density lipoprotein cholesterol (LDL-C) treatment goals.
OBJECTIVE: We evaluated the implications of widely adopting these optional goals in clinical practice.
DESIGN AND PARTICIPANTS: We performed a cross-sectional study using 1999 to 2002 data from 3,281 U.S. adults aged 20 to 79 years participating the National Health and Nutrition Examination Survey.
MEASUREMENTS: The primary outcomes were the proportions of adults whose fasting LDL-C levels exceeded NCEP recommended and optional targets from 2001 and 2004. We used survey weights to estimate the size of the U.S. population exceeding targets. We examined outcomes for 4 coronary disease risk subgroups described by the NCEP.
RESULTS: Low-density lipoprotein cholesterol values exceeded 2001 NCEP goals for 30.0% of adults, and 35.8% had levels above optional 2004 goals. An estimated 24,900,000 individuals (14.2%) exceeded 2001 thresholds for drug therapy, 46,200,000 (26.3%) exceeded optional 2001 thresholds for drug therapy, and 56,500,000 (32.2%) were above the optional 2004 thresholds for drug therapy. For lower, moderate, moderately high, and high-risk groups, 13.4%, 44.2%, 58.8%, and 71.8%, respectively, exceeded 2001 NCEP goals; 13.4%, 15.7%, 87.4%, and 96.0% of these groups exceeded optional 2004 thresholds for drug therapy.
CONCLUSIONS: In 1999 to 2002, LDL-C levels commonly exceeded 2001 NCEP goals, especially for moderately high and high-risk individuals, and cholesterol-lowering medications were underused. Optional goals promulgated by the NCEP in 2001 and 2004 moderately increased the number of adults with LDL-C above their goal, and greatly increased the number of low, moderately high, and high-risk adults who exceeded LDL-C thresholds, for cholesterol-lowering medication.