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(Circulation. 2006;113:598-600.)
© 2006 American Heart Association, Inc.

Editorial

Prevention of Coronary Heart Disease and the National Cholesterol Education Program

Lewis H. Kuller, MD, DrPH

From the Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, Pa.

Correspondence to Lewis H. Kuller, MD, DrPH, Department of Epidemiology, University of Pittsburgh, School of Public Health, Bellefield Ave, Bellefield Professional Bldg, Room 550, Pittsburgh, PA 15213. E-mail kullerl@edc.pitt.edu

Key Words: Editorials • atherosclerosis • epidemiology • lipids

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The incubation period for the progression of atherosclerosis to clinical disease is long, which provides an opportunity for risk factor modification and prevention of coronary heart disease (CHD). The National Cholesterol Education Program (NCEP) utilized the Framingham risk score (FRS) to classify individuals by level of risk to receive drug therapy and/or dietary counseling to lower low-density lipoprotein cholesterol (LDL-C) and raise high-density lipoprotein cholesterol (HDL-C). The rationale for choosing specific cutpoints for treatment was based on 3 key variables: (1) the efficacy of drug therapy to reduce the CHD incidence, (2) the safety of drug therapy, and (3) the cost of therapy.

Article p 647

The Multi-Ethnic Study of Atherosclerosis (MESA)¹ has reinforced previous observations that the guidelines are not being fully implemented. Many individuals are not treated or are undertreated. In MESA, only 54% were undergoing drug therapy, and only 40% of the dyslipidemic individuals had their blood cholesterol levels under control. This is overestimated, because individuals currently being treated with lipid-lowering drugs were dyslipidemic by NCEP criteria. Likely, many of these individuals were placed on therapy by doctors even if they did not meet the NCEP criteria. Not surprisingly, guidelines are being followed less for poorer individuals and minorities. A recent detailed report in Circulation discussed the reason for failure to follow guidelines and reduce lipid levels.² Almost all of the successful studies of diet or drug effectiveness have included the addition of nurses, nutritionists, health advisors, and good follow-up in addition to traditional physician-patient interactions. Unfortunately, . . . [Full Text of this Article]

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