1 / 16

Implications of Recent Clinical Trials for the NCEP ATP III Guidelines

Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines.

bertha-hardy
Télécharger la présentation

Implications of Recent Clinical Trials for the NCEP ATP III Guidelines

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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

  2. Implications of Recent Clinical Trials for the NCEP ATP III Guidelines Background • The Adult Treatment Panel (ATP III) of theNational Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001 Grundy, S. et al., Circulation 2004;110:227-39.

  3. Implications of Recent Clinical Trials for the NCEP ATP III Guidelines Background • 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 Grundy, S. et al., Circulation 2004;110:227-39.

  4. Implications of Recent Clinical Trials for the NCEP ATP III Guidelines Objective • To review the results of these recent trials and assess their implications for cholesterol management Grundy, S. et al., Circulation 2004;110:227-39.

  5. Log-Linear Relationship Between LDL-C Levels and Relative Risk for CHD 3.7 2.9 2.2 1.7 1.3 1.0 Relative Risk for Coronary Heart Disease (Log Scale) 40 70 100 130 160 190 LDL-Cholesterol (mg/dL) Grundy, S. et al., Circulation 2004;110:227-39.

  6. Doses of Currently Available Statins Required to Attain an Approximate 30% to 40% Reduction of LDL-C Levels (Standard Doses) † 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 Grundy, S. et al., Circulation 2004;110:227-39.

  7. 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.

  8. Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C Overview of Recommendations • 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 Grundy, S. et al., Circulation 2004;110:227-39.

  9. Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C High-Risk Persons • 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.

  10. Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C High-Risk Persons • 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.

  11. Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C High-Risk Persons • 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.

  12. Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C Moderately High-Risk Persons • 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.

  13. Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C Moderately High-Risk Persons • 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.

  14. Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C High Risk/Moderately High-Risk Persons • 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.

  15. Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C High Risk/Moderately High-Risk Persons • 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.

  16. Recommendations for Modifications to Footnotethe ATP III Treatment Algorithm for LDL-C Lower-Risk Persons • 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.

More Related