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(Circulation. 2002;105:136.)
© 2002 American Heart Association, Inc.

Editorials

Eligibility for Lipid-Lowering Drug Therapy in Primary Prevention

How Do the Adult Treatment Panel II and Adult Treatment Panel III Guidelines Compare?

Antonio M. Gotto, Jr, MD, DPhil; Lewis H. Kuller, MD DrPH

From the Joan and Sanford I. Weill Medical College of Cornell University (A.M.G.), New York, NY, and the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh (L.H.K.), Pittsburgh, Pa.

Correspondence to Antonio M. Gotto, Jr, MD, DPhil, c/o Paula Trushin, Weill Medical College of Cornell University, 445 E 69th St, Olin Hall 205, New York, NY 10021. E-mail amg_editorial@med.cornell.edu

Key Words: Editorials • drugs • prevention • atherosclerosis • cholesterol

In May 2001, the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program issued revised guidelines for diagnosing and treating high blood cholesterol.¹ These guidelines represent a major advance in risk assessment. They were preceded by the ATP I guidelines (1988), which focused on primary prevention of coronary heart disease (CHD), and by the ATP II guidelines (1993),² which discussed primary and secondary prevention. In the ATP II and ATP III guidelines, low-density lipoprotein cholesterol (LDL-C) is the primary target of risk-reduction therapy.

See p 152

The ATP II recommendations were based on epidemiological, preclinical, and incomplete clinical trial evidence. Within a few years after their publication, the results of 5 large-scale trials of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (ie, "statins") were reported. Two of these (West of Scotland Coronary Prevention Study [WOSCOPS] and Air Force/Texas Coronary Atherosclerosis Prevention Study [AFCAPS/TexCAPS]) were primary-prevention trials.^3,4 The remaining 3 focused on secondary prevention.^5-7 Based on these epic trials and other laboratory, epidemiological, and clinical evidence, the ATP III guidelines were developed (Tables 1 and 2).

View this table: [in this window] [in a new window]   Table 1. ATP III Guidelines: New Features

View this table: [in this window] [in a new window]   Table 2. ATP III Guidelines: Global Risk Assessment

Clinical Trial Evidence

The major statin trials and resulting meta-analyses provided a firm foundation for a truly evidence-based approach to guideline revision. Involving 5 different populations with widely varying absolute risk levels and using 3 different statins (simvastatin, pravastatin, lovastatin), they produced remarkably consistent reductions of 24% to 37% in relative risk for major CHD events. In WOSCOPS, 6595 men with moderate hypercholesterolemia (LDL-C=192 . . . [Full Text of this Article]

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				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]