Dyslipidemia remains a major contributor to the incidence of coronary heart disease (CHD), which causes 500 000 deaths and 1.1 million heart attacks each year in the United States. More than 70 million adult Americans have total cholesterol levels that exceed 200 mg/dL, and approximately 40 million have cholesterol levels greater than 240 mg/dL, the current definition of hypercholesterolemia.
Clearly, cholesterol control continues to be a major health concern within the American population. Elevations in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are independent risk factors for CHD regardless of a patient's age or gender. Without interventions, lifestyle and/or pharmaceutical, approximately one half of all Americans will die of CHD.
Since 1988, The National Cholesterol Education Program (NCEP) has convened a panel of experts, the Adult Treatment Panel (ATP), to develop guidelines to help healthcare providers better manage dyslipidemia in their patients. The newest issuance, ATP III, was released in May 2001, calling for even more stringent control of cholesterol levels than its predecessors, ATP I and ATP II. ATP III emphasizes the importance of intervening with the metabolic syndrome and the need for a more aggressive approach to testing and management of low density lipoprotein cholesterol (LDL-C), with a new focus on CHD prevention in people with multiple risk factors and diabetes mellitus. Despite a more vigorous emphasis on therapeutic lifestyle interventions, the new guidelines are expected to substantially expand the number of Americans being treated for high LDL-C with pharmaceutical interventions, when lifestyle modification fails to achieve necessary results.
This publication, based on the proceedings of a roundtable symposium of national authorities on cholesterol management that took place in Baltimore, Maryland, on December 4, 200l, is the first in a series of 3 issues that will focus on specific ATP III recommendations and their implications for clinical practice. In this issue, Roger S. Blumenthal, MD, Director of Preventive Cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, outlines the new guidelines and addresses possibilities for more successful of implementation of risk-reducing practices by offering a checklist, "ABCs of Preventive Cardiovascular Disease Risk Factor Management." In the roundtable discussion and case study that follow, several authorities in the field of dyslipidemia discuss current concepts and some of the key issues involved in the diagnosis and treatment of lipid disorders. These experts share their knowledge and experience from clinical practice, including views on how best to achieve lipid and triglyceride goals, the implications of emergent research for practicing physicians, and the possibilities of combination therapy. This issue includes a candid interview with Dr Dennis L. Sprecher, Section Head of Preventive Cardiology at the Cleveland Clinic, who discusses the underlying reasons for poor compliance among patients and their providers with previous iterations of ATP.
The next 2 installments of this series will explore, in detail, the implications of the guidelines for the treatment of patients with diabetes, and other special populations, possible considerations for the next release of ATP guidelines, and in-depth reports on the role of pharmacotherapy in achieving LDL goals.
*Professor of Medicine and Pediatrics, Johns Hopkins University School of Medicine, Director, Johns Hopkins University Lipid Clinic, Chief, Lipid Research, Johns Hopkins University Hospital, Baltimore, Maryland.