Journey in Guidelines for Lipid Management: From Adult Treatment Panel (ATP)-I to ATP-III and What to Expect in ATP-IV

Overview

Journal Indian J Endocrinol Metab

Specialty Endocrinology

Date 2013 Aug 21

PMID 23961478

Citations 17

Authors

P G Talwalkar

C G Sreenivas

Ashish Gulati

Hemang Baxi

Affiliations

Soon will be listed here.

Abstract

Adult Treatment Panel (ATP), an expert panel to supervise cholesterol management was set up under the aegis of National Cholesterol Education Program (NCEP) in 1985. Since then NCEP-ATP has been revising and framing guidelines to enable clinician to deliver better treatment to cardiovascular patients and to educate general people. As a result, considerable reduction in cardiovascular related deaths has been observed in recent times. All three ATP guidelines viz. ATP-I, ATP-II and ATP-III have targeted low density lipoprotein as their primary goal. The ATP-III guideline was updated in the light of evidences from 5-major clinical trials and was released in 2004. It added therapeutic lifestyle changes, concept of risk equivalents, Framingham CHD-risk score non-high density lipoprotein cholesterol (non-HDL-C) as secondary target and gave strong emphasis on metabolic risk factors. The earlier treat-to-target paradigm faced fierce criticism from clinicians across the globe because of insufficient proof of safety and benefits of treating patients with respect to an individual's low density lipoprotein (LDL) level. Further, demonstration of non-HDL-C and total cholesterol/HDL-C ratio as strong predictors of overall cardiovascular risk foresees new guidelines. A tailored-treatment approach was suggested instead of LDL-C target based treatment approach which was soundly based on direct clinical trials evidences and proposes treatment based on individual's overall 5- to 10-year cardiovascular risk irrespective of LDL-C level, leading to lower number of people on high dose/s of statins. Recent report of the Cholesterol Treatment Trialist's Collaborators meta-analysis strongly supported primary prevention of LDL with statins in low risk individuals and showed that its benefits completely outweighed its known hazards. Markers other than LDL-C like apolipoprotein B, non-HDL-C and total cholesterol/HDL-C ratio would take precedence in the risk assessment and strong emphasis would be given on tailored-treatment approach in the upcoming ATP-IV guideline.

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References

Hayward R, Krumholz H, Zulman D, Timbie J, Vijan S . Optimizing statin treatment for primary prevention of coronary artery disease. Ann Intern Med. 2010; 152(2):69-77. DOI: 10.7326/0003-4819-152-2-201001190-00004. View

Braunstein J, Cheng A, COHN G, Aggarwal M, Nass C, Blumenthal R . Lipid disorders: justification of methods and goals of treatment. Chest. 2001; 120(3):979-88. DOI: 10.1378/chest.120.3.979. View

Anderson K, Wilson P, Odell P, Kannel W . An updated coronary risk profile. A statement for health professionals. Circulation. 1991; 83(1):356-62. DOI: 10.1161/01.cir.83.1.356. View

Mihaylova B, Emberson J, Blackwell L, Keech A, Simes J, Barnes E . The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012; 380(9841):581-90. PMC: 3437972. DOI: 10.1016/S0140-6736(12)60367-5. View

Lipsy R . Effective management of patients with dyslipidemia. Am J Manag Care. 2003; 9(2 Suppl):S39-58. View

Sattar N, Preiss D, Murray H, Welsh P, Buckley B, de Craen A . Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010; 375(9716):735-42. DOI: 10.1016/S0140-6736(09)61965-6. View

Krumholz H, Hayward R . Shifting views on lipid lowering therapy. BMJ. 2010; 341:c3531. DOI: 10.1136/bmj.c3531. View

Shepherd J, Blauw G, Murphy M, Bollen E, Buckley B, Cobbe S . Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002; 360(9346):1623-30. DOI: 10.1016/s0140-6736(02)11600-x. View

. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA. 2002; 288(23):2998-3007. DOI: 10.1001/jama.288.23.2998. View

10.

Pasternak R . Report of the Adult Treatment Panel III: the 2001 National Cholesterol Education Program guidelines on the detection, evaluation and treatment of elevated cholesterol in adults. Cardiol Clin. 2003; 21(3):393-8. DOI: 10.1016/s0733-8651(03)00080-8. View

11.

Sniderman A, Williams K, Contois J, Monroe H, McQueen M, de Graaf J . A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes. 2011; 4(3):337-45. DOI: 10.1161/CIRCOUTCOMES.110.959247. View

12.

Ansell B, Watson K, Fogelman A . An evidence-based assessment of the NCEP Adult Treatment Panel II guidelines. National Cholesterol Education Program. JAMA. 1999; 282(21):2051-7. DOI: 10.1001/jama.282.21.2051. View

13.

Armitage J . The safety of statins in clinical practice. Lancet. 2007; 370(9601):1781-90. DOI: 10.1016/S0140-6736(07)60716-8. View

14.

CASTELLI W, Anderson K, Wilson P, Levy D . Lipids and risk of coronary heart disease. The Framingham Study. Ann Epidemiol. 1992; 2(1-2):23-8. DOI: 10.1016/1047-2797(92)90033-m. View

15.

. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106(25):3143-421. View

16.

Grundy S, Cleeman J, Merz C, Brewer Jr H, Clark L, Hunninghake D . Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004; 110(2):227-39. DOI: 10.1161/01.CIR.0000133317.49796.0E. View

17.

Assmann G, Gotto Jr A . HDL cholesterol and protective factors in atherosclerosis. Circulation. 2004; 109(23 Suppl 1):III8-14. DOI: 10.1161/01.CIR.0000131512.50667.46. View

18.

Warnick G, Myers G, Cooper G, Rifai N . Impact of the third cholesterol report from the adult treatment panel of the national cholesterol education program on the clinical laboratory. Clin Chem. 2001; 48(1):11-7. View

19.

Hayward R . All-or-nothing treatment targets make bad performance measures. Am J Manag Care. 2007; 13(3):126-8. View

20.

Glasziou P, Irwig L, Heritier S, Simes R, Tonkin A . Monitoring cholesterol levels: measurement error or true change?. Ann Intern Med. 2008; 148(9):656-61. DOI: 10.7326/0003-4819-148-9-200805060-00005. View