DOCTOR'S VIEW ARCHIVE
Cholesterol Guidelines for Adults (2001)
In July of 2004, the National Cholesterol Education Program released
updated guidelines. For this up-to-date information, please read the New
Cholesterol Guidelines article.
The Third Report Of The National Cholesterol Education Program (NCEP)
Scientists have made great strides in the past decade in
preventing coronary heart disease (CHD). The most common form of CHD is a heart attack.
Lowering cholesterol, especially the LDL form of cholesterol, is the most important
aspect of preventing CHD.
The National Cholesterol Education Program (NCEP) published a set of
guidelines for the testing and the management of high blood cholesterol in
adults in the Journal of the American Medical Association (May 16, 2001). These new guidelines, produced
by a panel of experts, are an update of the guidelines published by the NCEP in
1993. The NCEP periodically publishes guideline updates as warranted by advances
in the science of cholesterol and CHD prevention.
The new NCEP guidelines address the following issues:
- Who should undergo blood cholesterol screening and what
blood lipids (fats) should be checked?
- What are the desirable and undesirable levels of different
- What should be the first priority (the primary target) in
- How is a person's risk of developing CHD estimated?
- How low should LDL cholesterol be?
- What is Therapeutic Lifestyle Change (TLC)?
- Who should be placed on Therapeutic Lifestyle Change
- Who should be considered for lipid-lowering medications?
- What is metabolic syndrome?
- How is metabolic syndrome treated?
- Management Of High Blood Cholesterol In Adults At A Glance
Who should undergo blood cholesterol screening and what
blood lipids should be checked?
Men and women 20 years and older should undergo cholesterol screening
every 5 years. Blood samples should be obtained after fasting and should be
tested for total cholesterol, LDL cholesterol, HDL cholesterol, and
What are the desirable and undesirable levels of different
cholesterol is the bad cholesterol because high blood LDL levels increase the
risk of CHD. HDL cholesterol is the good cholesterol because low HDL levels
increase the risk of CHD while high HDL levels help protect a person from
developing CHD. High levels of triglycerides are also believed to increase the
risk of CHD.
LDL cholesterol (mg/dl)
100-129 Near or above optimal
130-159 Borderline high
190 Very high
Total cholesterol (mg/dl)
200-239 Borderline high
HDL cholesterol (mg/dl)
What should be the first priority
(the primary target) in
Elevated LDL cholesterol is a major cause of CHD.
Lowering LDL cholesterol by diet and medications has been shown in numerous
to significantly reduce the risk of CHD (such as heart attacks and strokes). Therefore,
lowering LDL cholesterol is the first priority in preventing CHD.
While NCEP expert panel designates LDL cholesterol of less than (<) 100
mg/dl as the optimal level, the panel is not recommending this level for all
people. Instead, the target level (goal) of LDL cholesterol lowering is tailored
to a person's CHD risk. People with the highest CHD risks should have their
LDL cholesterol lowered below 100 mg/dl, while people with lesser CHD risks will
have higher LDL cholesterol target levels.
How is a person's risk of developing CHD estimated?
The CHD risk calculation is based on a scoring system that grew out of
the Framingham Heart Study. A person's risk (chance) of developing CHD in the
next 10 years is calculated based on the cholesterol level as well as other
non-cholesterol risk factors. The non-cholesterol risk factors are classified as
highest risk factors, major risk factors, and other risk factors.
The highest risk factors include:
- Diabetes mellitus
- Having already developed CHD, as evidenced by a prior
heart attack, bypass surgery, etc.
- Having already developed arteriosclerosis (hardening
and narrowing) in arteries other than the heart. Arteriosclerosis in the other
arteries can lead to poor circulation in the lower extremities, aneurysm of
the abdominal aorta, and stroke.