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:

  1. Who should undergo blood cholesterol screening and what blood lipids (fats) should be checked?
  2. What are the desirable and undesirable levels of different blood lipids?
  3. What should be the first priority (the primary target) in preventing CHD?
  4. How is a person's risk of developing CHD estimated?
  5. How low should LDL cholesterol be?
  6. What is Therapeutic Lifestyle Change (TLC)?
  7. Who should be placed on Therapeutic Lifestyle Change (TLC)?
  8. Who should be considered for lipid-lowering medications?
  9. What is metabolic syndrome?
  10. How is metabolic syndrome treated?
  11. 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 triglycerides.

What are the desirable and undesirable levels of different blood lipids?

LDL 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 Optimal
100-129 Near or above optimal
130-159 Borderline high
160-189 High
> 190 Very high

Total cholesterol (mg/dl)


<200 Desirable
200-239 Borderline high
>240 High

HDL cholesterol (mg/dl)

<40 Low (undesirable)
>60 High (desirable)

Triglycerides (mg/dl)

<150 Normal
150-199 Borderline-high
200-499 High
>500 Very high

What should be the first priority (the primary target) in preventing CHD?

Elevated LDL cholesterol is a major cause of CHD. Lowering LDL cholesterol by diet and medications has been shown in numerous clinical trials 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:

  1. Diabetes mellitus
  2. Having already developed CHD, as evidenced by a prior heart attack, bypass surgery, etc.
  3. 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.