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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines,Scott M. Grundy; James I. Cleeman; C. Noel Bairey Merz; H. Bryan Brewer, Jr.; Luther T. Clark; Donald B. Hunninghake; Richard C. Pasternak; Sidney C. Smith, Jr.; Neil J. Stone; for the Coordinating Committee of the National Cholesterol Education Program,Implications of Recent Clinica,The Adult Treatment Panel (ATP III) of theNational Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001,Implications of Recent Clinical Trials for the NCEP ATP III Guidelines,Background,Grundy, S. et al.,Circulation,2004;110:227-39.,The Adult Treatment Panel (ATP,Since the publication of ATP III, 5 major clinical trials of statin therapy with clinical end points have been published,These trials addressed issues that were not examined in previous clinical trials of cholesterol-lowering therapy,Background,Grundy, S. et al.,Circulation,2004;110:227-39.,Implications of Recent Clinical Trials for the NCEP ATP III Guidelines,Since the publication of ATP I,To review the results of these recent trials and assess their implications for cholesterol management,Objective,Grundy, S. et al.,Circulation,2004;110:227-39.,Implications of Recent Clinical Trials for the NCEP ATP III Guidelines,To review the results of these,Log-Linear Relationship Between LDL-C Levels and Relative Risk for CHD,3.7,2.9,2.2,1.7,1.3,1.0,40 70 100 130 160 190,Relative Risk for Coronary Heart Disease (Log Scale),LDL-Cholesterol (mg/dL),Grundy, S. et al.,Circulation,2004;110:227-39.,Log-Linear Relationship Betwee,Drug,Dose, mg/d,LDL Reduction, %,Atorvastatin,10,39,Lovastatin,40,31,Pravastatin,40,34,Simvastatin,20-40,35-41,Fluvastatin,40-80,25-35,Rosuvastatin,5-10,39-45,Doses of Currently Available Statins Required to Attain an Approximate 30% to 40% Reduction of LDL-C Levels (Standard Doses),Grundy, S. et al.,Circulation,2004;110:227-39., All of these are available at doses up to 80 mg. For every doubling of the dose above the standard dose, an approximate 6% decrease in LDL-C level can be obtained., For rosuvastatin, doses available up to 40 mg; the efficacy for 5 mg is estimated by subtracting 6% from the FDA reported efficacy at 10 mg,DrugDose, mg/dLDL Reduction,Risk Category,LDL-C Goal,Initiate TLC,Consider Drug Therapy,High risk:,CHD or CHD risk equivalents (10-year risk 20%),100 mg/dL (optional goal: 70 mg/dL),100 mg/dL,100 mg/dL (100 mg/dL: consider drug options),Moderately high risk:,2+ risk factors (10-year risk 10% to 20%),130 mg/dL,130 mg/dL,130 mg/dL (100-129 mg/dL: consider drug options),Moderate risk:,2+ risk factors (10 year risk 10%),130 mg/dL,130 mg/dL,160 mg/dL,Lower risk:,0-1 risk factor,160 mg/dL,160 mg/dL,190 mg/dL (160-189 mg/dL: LDL-lowering drug optional),ATP III LDL-C Goals and Cutpoints for TLC and Drug Therapy in Different Risk Categories and Proposed Modifications Based on Recent Clinical Trial Evidence,Grundy, S. et al.,Circulation,2004;110:227-39.,Risk CategoryLDL-C GoalInit,Therapeutic lifestyle changes (TLC) remain an essential modality in clinical management,TLC have the potential to reduce CV risk through several mechanisms beyond LDL lowering,Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C,Grundy, S. et al.,Circulation,2004;110:227-39.,Overview of Recommendations,Therapeutic lifestyle changes,Recommended LDL-C goal is 100 mg/dL,An LDL-C goal of 70 mg/dL is a therapeutic option on the basis of available clinical trial evidence, especially for patients at very high risk,If LDL-C is,100 mg/dL, an LDL-lowering drug is indicated simultaneously withlifestyle changes,Grundy, S. et al.,Circulation,2004;110:227-39.,High-Risk Persons,Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C,Recommended LDL-C goal is 100,Recommended LDL-C goal is 100 mg/dL,If baseline LDL-C is 100 mg/dL, institution of an LDL-lowering drug to achieve an LDL-C level 70 mg/dL is a therapeutic option on the basis of available clinical trial evidence,Grundy, S. et al.,Circulation,2004;110:227-39.,High-Risk Persons,Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C,Recommended LDL-C goal is 100,Recommended LDL-C goal is 100 mg/dL,If a high-risk person has high triglycerides or low HDL-C, consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug,When triglycerides are,200 mg/dL, non-HDL-C is a secondary target of therapy, with a goal 30 mg/dL higher than the identified LDL-C goal,Grundy, S. et al.,Circulation,2004;110:227-39.,High-Risk Persons,Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C,Recommended LDL-C goal is 100,Recommended LDL-C goal is 130 mg/dL,An LDL-C goal 100 mg/dL is a therapeutic option on the basis of available clinical trial evidence,Grundy, S. et al.,Circulation,2004;110:227-39.,Moderately High-Risk Persons,Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C,Recommended LDL-C goal is 130,Recommended LDL-C goal is 100 mg/dL,When LDL-C level is 100 to 129 mg/dL, at baseline or on lifestyle therapy, initiation of an LDL-lowering drug to achieve an LDL-C level 100 mg/dL is a therapeutic option on the basis of available clinical trial evidence,Grundy, S. et al.,Circulation,2004;110:227-39.,Moderately High-Risk Persons,Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C,Recommended LDL-C goal is 100,Any person at high risk or moderately high risk who has lifestyle-related risk factors (e.g., obesity, physical inactivity, elevated triglyceride, low HDL-C, or metabolic syndrome) is a candidate for TLC to modify these risk factors regardless of LDL-C level,Grundy, S. et al.,Circulation,2004;110:227-39.,High Risk/Moderately High-Risk Persons,Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C,Any person at high risk or mod,When LDL-lowering drug therapy is employed in high-risk or moderately high-risk persons, it is advised that intensity of therapy be sufficient to achieve at least a 30% to 40% reduction in LDL-C levels,Grundy, S. et al.,Circulation,2004;110:227-39.,High Risk/Moderately High-Risk Persons,Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C,When LDL-lowering drug therapy,For people in lower-risk categories, recent clinical trials do not modify the goals and cutpoints of therapy,Grundy, S. et al.,Circulation,2004;110:227-39.,Lower-Risk Persons,Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C,For people in lower-risk categ,20,19,POWERPOINT,SUCCESS,2024/8/26,2019POWERPOINTSUCCESS2023/9/1,20,19,THANK YOU,SUCCESS,2024/8/26,2019THANK YOUSUCCESS2023/9,
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