CARDIOLOGY

Recall National Cholesterol Education Program Panel guidelines for use of diet and drugs to lower cholesterol.

Explanation:

NCEP 1993 JAMA guidelines are the landmark for cholesterol management. They got revised by the 3rd report (ATP III - Adult treatment panel III - 2001)

Three categories are there category A of those with one or no risk factor Category B are those with 2 or more risk factors Category C are those with CAD. ATP III raised diabetics to category C. Risk Factors are those for CAD and also being a male >45 or female >55 or premature menopause without HRT,HDL<40 (Used to be 35).

HDL >60 is the only negative risk factor therefore subtract one risk factor if HDL is >60.

The target LDL in groups A/B/C are 160/130/100 respectively. Anyone having LDL level > target for the group they belong to should try dietary control first-always for 12 weeks. Check TOTAL CHOLESTEROL at 4/8/ weeks. Total cholesterol 240 & 200 correspond to LDL of 160 & 130 respectively. This tells you if the diet needs to be more stringent. At the end of 12 weeks check the LDL and if >30 above the target level - start drug therapy. If above target but not above absolute criteria for drug therapy then it is individual decision of risk/benefit of drug side effects versus drug benefit. We currently know that it is better to start therapy.

Also review HTN guidelines - JNC7