This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fedder, D. O. Articles by L’Italien, G. J. Search for Related Content PubMed PubMed Citation Articles by Fedder, D. O. Articles by L’Italien, G. J. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Cholesterol Related Collections Lipids Primary prevention Epidemiology

(Circulation. 2002;105:152.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

New National Cholesterol Education Program III Guidelines for Primary Prevention Lipid-Lowering Drug Therapy

Projected Impact on the Size, Sex, and Age Distribution of the Treatment-Eligible Population

Donald O. Fedder, DrPH; Carol E. Koro, MS; Gilbert J. L’Italien, PhD

From the University of Maryland (D.O.F., C.E.K., G.J.L.), Pharmaceutical Health Services Research Department, Baltimore, Md, and Bristol-Myers Squibb Pharmaceutical Research Institute (G.J.L.), Princeton, NJ.

Correspondence to Donald O. Fedder, DrPH, 506 W Fayette St, Suite 201, Baltimore, MD 21201. E-mail dfedder{at}rx.umaryland.edu

Background— The guidelines in the Third Report of the National Cholesterol Education Program (NCEP III) include absolute risk and lower LDL cholesterol (LDL-C) levels to assess eligibility for lipid-lowering drug therapy. We studied the impact of these changes on the size, sex, and age distribution of the target US population using data from the Third Annual National Health and Nutrition Survey (NHANES III) (1988 to 1994).

Methods and Results— A subsample of NHANES III participants aged 20 to 79 years with known cardiovascular risk factors and LDL-C levels was identified (n=13 589). We assessed their eligibility for drug therapy first using NCEP II guidelines and then using the new NCEP III criteria. We also calculated the number eligible for LDL-C lowering to <100 mg/dL. An estimated 15 million individuals aged 20 to 79 years are eligible for drug therapy under NCEP II; 51% are males, 49% are females, 26% are <45 years old, and 28% are 65 years old. Under NCEP III, 36 million would be eligible for treatment; 55% are males, 45% are females, 32% are <45 years old, and 27% are 65 years old. This represents a 140% increase in eligibility overall, a 157% increase among males, a 122% increase among females, a 131% increase among those 65 years old, and a 201% increase among those <45 years old. Of treatment-eligible individuals, 26% of males, 24% of females, 39% of elderly, and 14% of those <45 years old are targeted for LDL-C lowering to <100 mg/dL.

Conclusions— The NCEP III guidelines will alter the age and sex distributions of the treatment-eligible population, targeting many more younger (<45 years old) and greater numbers of elderly (65 years) individuals, particularly for aggressive intervention.

Key Words: epidemiology • lipids • prevention • cholesterol

This article has been cited by other articles:

				J A Singh, J S Hodges, and S M Asch Opportunities for improving medication use and monitoring in gout Ann Rheum Dis, August 1, 2009; 68(8): 1265 - 1270. [Abstract] [Full Text] [PDF]

				G. P. Van Guilder, G. L. Hoetzer, J. J. Greiner, B. L. Stauffer, and C. A. DeSouza Acute and chronic effects of vitamin C on endothelial fibrinolytic function in overweight and obese adult humans J. Physiol., July 15, 2008; 586(14): 3525 - 3535. [Abstract] [Full Text] [PDF]

				J.E. Naschitz and R. Lenger Why traumatic leg amputees are at increased risk for cardiovascular diseases QJM, April 1, 2008; 101(4): 251 - 259. [Abstract] [Full Text] [PDF]

				G. P. Van Guilder, B. L. Stauffer, J. J. Greiner, and C. A. DeSouza Impaired endothelium-dependent vasodilation in overweight and obese adult humans is not limited to muscarinic receptor agonists Am J Physiol Heart Circ Physiol, April 1, 2008; 294(4): H1685 - H1692. [Abstract] [Full Text] [PDF]

				M A Smith, E D Cox, and J M Bartell Overprescribing of lipid lowering agents. Qual. Saf. Health Care, August 1, 2006; 15(4): 251 - 257. [Abstract] [Full Text] [PDF]

				G. P. Van Guilder, G. L. Hoetzer, D. T. Smith, H. M. Irmiger, J. J. Greiner, B. L. Stauffer, and C. A. DeSouza Endothelial t-PA release is impaired in overweight and obese adults but can be improved with regular aerobic exercise Am J Physiol Endocrinol Metab, November 1, 2005; 289(5): E807 - E813. [Abstract] [Full Text] [PDF]

				C. I. Ardern, P. T. Katzmarzyk, I. Janssen, T. S. Church, and S. N. Blair Revised Adult Treatment Panel III Guidelines and Cardiovascular Disease Mortality in Men Attending a Preventive Medical Clinic Circulation, September 6, 2005; 112(10): 1478 - 1485. [Abstract] [Full Text] [PDF]

				A. Thompson and N. J Temple The case for statins: has it really been made? J R Soc Med, October 1, 2004; 97(10): 461 - 464. [Full Text] [PDF]

				R. C. Pasternak, J. Abrams, P. Greenland, L. A. Smaha, P. W. F. Wilson, and N. Houston-Miller Task force #1--identification of coronary heart disease risk: is there a detection gap? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1863 - 1874. [Full Text] [PDF]

				D. B. Mark, L. J. Shaw, M. S. Lauer, P. G. O'Malley, and P. Heidenreich Task force #5--is atherosclerosis imaging cost effective? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1906 - 1917. [Full Text] [PDF]

				K. O. Akosah, A. Schaper, C. Cogbill, and P. Schoenfeld Preventing myocardial infarction in the young adult in the first place: how do the national cholesterol education panel iii guidelines perform? J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1475 - 1479. [Abstract] [Full Text] [PDF]

				I. Dussault, R. Beard, M. Lin, K. Hollister, J. Chen, J.-H. Xiao, R. Chandraratna, and B. M. Forman Identification of Gene-selective Modulators of the Bile Acid Receptor FXR J. Biol. Chem., February 21, 2003; 278(9): 7027 - 7033. [Abstract] [Full Text] [PDF]

				D. O. Fedder, C. E. Koro, G. J. L'Italien, A. M. Gotto Jr, and L. H. Kuller Primary Prevention Lipid-Lowering Drug Therapy * Response Circulation, August 13, 2002; 106 (7): e35 - e36. [Full Text] [PDF]

				J. S. Benner, R. J. Glynn, H. Mogun, P. J. Neumann, M. C. Weinstein, and J. Avorn Long-term Persistence in Use of Statin Therapy in Elderly Patients JAMA, July 24, 2002; 288(4): 455 - 461. [Abstract] [Full Text] [PDF]

				A. C. Yeung and P. Tsao Statin Therapy: Beyond Cholesterol Lowering and Antiinflammatory Effects Circulation, June 25, 2002; 105(25): 2937 - 2938. [Full Text] [PDF]

				J. R Chiong and A. B Miller Review: Renin-angiotensin system antagonism and lipid-lowering therapy in cardiovascular risk management Journal of Renin-Angiotensin-Aldosterone System, June 1, 2002; 3(2): 96 - 102. [Abstract] [PDF]

				How Many Patients Are Now Eligible for Lipid-Lowering Drug Therapy? Journal Watch Cardiology, March 22, 2002; 2002(322): 3 - 3. [Full Text]

				A. M. Gotto Jr and L. H. Kuller Eligibility for Lipid-Lowering Drug Therapy in Primary Prevention: How Do the Adult Treatment Panel II and Adult Treatment Panel III Guidelines Compare? Circulation, January 15, 2002; 105(2): 136 - 139. [Full Text] [PDF]