ATP III Cholesterol Guidelines
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Estimate of 10-Year Risk for Men Women
Age 20-34 years 35-39 years 40-44 years 45-49 years 50-54 years 55-59 years 60-64 years 65-69 years 70-74 years 75-79 years
Total Cholesterol <160 mg/dL (<4.14 mmol/L) 160-199 mg/dL (4.14-5.15 mmol/L) 200-239 mg/dL (5.18-6.19 mmol/L) 240-279 mg/dL (6.22-7.23 mmol/L) >=280 mg/dL (>=7.25 mmol/L)
HDL Cholesterol >=60 mg/dL (>=1.55 mmol/L) 50-59 mg/dL (1.29-1.53 mmol/L) 40-49 mg/dL (1.04-1.27 mmol/L) <40 mg/dL (<1.04 mmol/L)
Smoker Yes No
Systolic BP (mmHg) <120 120-129 130-139 140-159 >=160
On Blood pressure medication (Yes or No) Yes No
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ATP III Cholesterol Guidelines

This information is based upon the update to the 2001 Adult Treatment Panel III (ATP III) that was published in 2004. Additional data led to updating of lipid goals in patients based upon risk category.

There are 4 risk categories defined (abbreviations and additional information listed below):

  • High Risk
    • CHD, CHD risk equivalents, or 10 year risk >20%
    • LDL-C Goal is <100 mg/dL
    • LCL-C Goal of <70 mg/dL can be considered in very high-risk patients such as recent myocardial infarction, CHD combined with other risks such as diabetes, continued smoking, metabolic syndrome or other risk factors
    • TLC initiated at LDL-C >=100 mg/dL
    • Drug therapy considered at LDL-C >=100 mg/dL
  • Moderately high risk
    • 2+ risk factors, and 10 year risk 10-20%
    • LDL-C Goal is <130 mg/dL
    • TLC initiated at LDL-C >=130 mg/dL
    • Drug therapy considered at LDL-C >=130 mg/dL in most cases; however, those some consideration of lowering cholesterol when baseline LDL-C is 100-129 mg/dL to <100 mg/dL should be considered
  • Moderate risk
    • 2+ risk factors, and 10 year risk <10%
    • LDL-C Goals is <130 mg/dL
    • TLC initiated at LDL-C >=130 mg/dL
    • Drug therapy considered at LDL-C >=160 mg/dL
  • Lower risk
    • 0-1 risk factor
    • LDL-C Goals is <160 mg/dL
    • TLC initiated at LDL-C >=160 mg/dL
    • Drug therapy considered at LDL-C >=190 mg/dL (may consider LDL lowering drug as option in range of LDL-C 160-189 mg/dL)

Definitions/Details:

  • CHD includes history of myocardial infarction, unstable angina, stable angina, coronary artery procedures (angioplasty, bypass surgery) or evidence of clinically significant myocardial ischemia
  • CHD risk equivalents include
    • Evidence of noncoronary atherosclerotic disease such as peripheral artery disease, abdominal aortic aneurysm and carotid artery disease (TIA, Stroke of carotid origin, >50% obstruction of carotid artery)
    • Diabetes
    • 2+ risk factors with 10 years risk for CHD >20%
  • Risk factors include
    • Cigarette smoking
    • Hypertension (BP >=140/90 mmHg or on antihypertensive medication)
    • HDL-C<40 mg/dL
    • Family history of premature CHD (1 st degree relative, male <55 years old or female <65 years old)
    • Age >=45 years (male) or >=55 years (female)
  • TLC = Therapeutic lifestyle changes and is indicated in any person at high or moderate risk (regardless of LDL-C level) who has lifestyle related risk factors such as:
    • Obesity
    • Physical inactivity
    • Elevated triglycerides
    • Low HDL-C
    • Metabolic syndrome
  • TLC includes:
    • Low saturated fat diet (<7% of calories)
    • Low cholesterol diet (<20 mg/day)
    • Increased viscous (soluble fiber) 10-25 grams/day
    • Increased plant stanols/sterols (2 grams/day)
    • Physical activity
    • Weight control
  • When LDL lowering therapy is used, the intensity of therapy should be sufficient to achieve at least a 30-40% reduction in the LDL-C level

Reference:

Grundy SM, Cleeman JI, Merz CN, et al. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation . 2004;110:227-39.