IV. General Approach to Treatment—Goals and Thresholds

Abstract

The basic principle that guides cholesterol-lowering intervention is that the intensity of treatment is directly related to the degree of risk for CHD events. Both short-term (10-year) risk and long-term risk must be considered for treatment decisions. Persons with existing CHD (or a CHD risk equivalent) are at the highest risk; for this reason, they have the lowest goal level for LDL cholesterol and receive the most intensive treatment. For persons without CHD, classification and treatment goals are based on the category of risk, of which there are two—multiple (2+) risk factors other than LDL, and 0-1 risk factor. Persons with 2+ risk factors have an LDL goal that is not quite as low as that for persons with CHD (or CHD risk equivalents). ATP III differs from ATP II in that it distinguishes three subcategories of risk among persons with multiple (2+) risk factors: 10-year risk for hard CHD >20 percent, 10-20 percent, and <10 percent. Among the group with multiple risk factors, those at highest risk receive the most intensive LDL-lowering therapy, and those with the lowest risk receive the least intensive therapy. For persons with 0-1 risk factor, LDL goal levels are not as low as for persons with multiple risk factors, and intensive LDL-lowering therapy is not required unless LDL cholesterol levels are very high. ATP III recommends that LDL cholesterol be the primary target of therapy. The LDL cholesterol goals for each risk category are shown in Table IV.1-1. View this table: Table IV.1-1. LDL Cholesterol Goals for Three Risk Levels Persons with CHD or CHD risk equivalent have an LDL cholesterol goal of 20 percent per 10 years) who has an LDL cholesterol goal …