|100-129||Near Optimal/Above Optimal|
Note: in ATP III, diabetes is regarded as a CHD risk equivalent.
|Risk Category||LDL Goal||LDL Level at Which to Initiate Therapeutic Lifestyle Changes (TLC)||LDL Level at Which to Consider Drug Therapy|
|CHD or CHD Risk Equivalents (10-year risk >20%)||<100 mg/dL||100 mg/dL||130 mg/dL (100-129 mg/dL: drug optional)*|
|2+ Risk Factors (10-year risk 20%)||<130 mg/dL||130 mg/dL||10-year risk 10-20%: 130 mg/dL
10-year risk <10%: 160 mg/dL
|0-1 Risk Factor**||<160 mg/dL||160 mg/dL||190 mg/dL
(160-189 mg/dL: LDL-lowering drug optional)
* Some authorities recommend use of LDL-lowering drugs in this category if an LDL cholesterol <100 mg/dL cannot be achieved by therapeutic lifestyle changes. Others prefer use of drugs that primarily modify triglycerides and HDL, e.g., nicotinic acid or fibrate. Clinical judgment also may call for deferring drug therapy in this subcategory.
** Almost all people with 0-1 risk factor have a 10-year risk <10%, thus 10-year risk assessment in people with 0-1 risk factor is not necessary.
|Drug Class||Agents and Daily Doses||Lipid/Lipoprotein Effects||Side Effects||Contraindications|
|HMG CoA reductase inhibitors (statins)||Lovastatin (20-80 mg), Pravastatin (20-40 mg), Simvastatin (20-80 mg), Fluvastatin (20-80 mg), Atorvastatin (10-80 mg), Cerivastatin (0.4-0.8 mg)||LDL-C 18-55%
Increased liver enzymes
|Bile acid Sequestrants||Cholestyramine (4-16 g) Colestipol (5-20 g) Colesevelam (2.6-3.8 g)||LDL-C 15-30%
TG No change or increase
Decreased absorption of other drugs
|Nicotinic acid||Immediate release (crystalline) nicotinic acid (1.5-3 gm), extended release nicotinic acid (Niaspan ®) (1-2 g), sustained release nicotinic acid (1-2 g)||LDL-C 5-25%
Hyperuricemia (or gout)
Upper GI distress
|Fibric acids||Gemfibrozil (600 mg BID)
Fenofibrate (200 mg)
Clofibrate (1000 mg BID)
|LDL-C 5-20% (may be increased in patients with high TG)
* Cyclosporine, macrolide antibiotics, various anti-fungal agents, and cytochrome P-450 inhibitors (fibrates and niacin should be used with appropriate caution).
|Risk Factor||Defining Level|
>102 cm (>40 in)
>88 cm (>35 in)
|blood pressure||130/85 mmHg|
|Fasting glucose||110 mg/dL|
* Overweight and obesity are associated with insulin resistance and the metabolic syndrome. However, the presence of abdominal obesity is more highly correlated with the metabolic risk factors than is an elevated body mass index (BMI). Therefore, the simple measure of waist circumference is recommended to identify the body weight component of the metabolic syndrome.
** Some male patients can develop multiple metabolic risk factors when the waist circumference is only marginally increased, e.g., 94-102 cm (37-39 in). Such patients may have a strong genetic contribution to insulin resistance. They should benefit from changes in life habits, similarly to men with categorical increases in waist circumference.
< 150 Normal 150-199 Borderline high 200-499 High 500 Very high
|Risk Category||LDL Goal (mg/dL)||Non-HDL Goal (mg/dL)|
|CHD and CHD Risk Equivalent (10-year risk for CHD >20%)||<100||<130|
|Multiple (2+) Risk Factors and 10-year risk 20%||<130||<160|
|0-1 Risk Factor||<160||<190|