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LipidManagement™ is certified
for CME credit. This issue includes a CME posttest covering
all four issues from 2001.
LEARNING OBJECTIVES
After reading the articles in this issue of LipidManagement™,
participants should be able to:
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Identify the novel, or emerging, risk
factors being studied for their usefulness in predicting
heart-disease risk and in evaluating risk-reduction therapy |
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Discuss the clinical trials being conducted
to determine these emerging risk factors' value to cardiovascular-disease
risk assessment |
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Recognize the importance of
diagnosing and treating outlying lesions in addition to
the culprit lesion in a patient presenting with AMI |
Intended audience:
primary care physicians, cardiologists, endocrinologists
Release date: December 20, 2001
End date: December 31, 2002
This newsletter series is sponsored by Professional Postgraduate
Services® (PPS), a division
of Physicians World/Thomson Healthcare.
PPS is accredited by the Accreditation Council
for Continuing Medical Education to provide continuing medical
education for physicians.
PPS designates this educational activity for a maximum
of 2 hours in category 1 credit toward the AMA Physician’s Recognition
Award. Each physician should claim only those hours of credit
that he/she actually spent in the educational activity.
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Risk Factors Emerge in ATP III
The Third Adult Treatment Panel (ATP III) of the National Cholesterol
Education Program recognizes that primary prevention of CHD in persons
with multiple risk factors is best accomplished by aggressively lowering
LDL-C with lifestyle modifications and, if necessary, pharmacologic
interventions.1 However, ATP III
emphasizes the importance of global risk assessment by recognizing
that CHD risk is influenced by factors other than those designated
as major (ie, elevated LDL-C, cigarette smoking, hypertension, low
HDL-C level, family history of premature CHD, and age). These include
life-habit risk factors (eg, obesity, physical inactivity,
atherogenic diet) and emerging risk factors (eg, Lp[a], Hcy,
and proinflammatory factors such as CRP). Although these emerging
risk factors do not categorically modify LDL-C goals, they appear
to contribute to CHD risk and can be used to guide the intensity of
risk-reduction therapy in certain patients.
The metabolic syndrome, a constellation of major,
life-habit, and emerging risk factors, increases CHD risk at any
LDL-C level. Elevated serum TG concentrations, which are one feature
of the metabolic syndrome, are an independent CHD risk factor. This
suggests that some triglyceride-rich lipoproteins (ie, partially
degraded VLDL-C particles, also called remnant lipoproteins)
are atherogenic. In clinical practice, VLDL-C serves as the most
readily available measure of remnant lipoproteins. ATP III identifies
the sum of LDL-C and VLDL-C (or, alternatively, TC minus HDL-C),
termed non–HDL-C, as a secondary target of therapy in
patients with high TG (>200 mg/dL). Based on the premise
that a VLDL-C level <30 mg/dL is normal, the goal for
non–HDL-C in these patients can be set at 30 mg/dL higher than
that for LDL-C. Thus, non–HDL-C goals for the three ATP III
risk categories are as follows:
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<130 mg/dL for persons with CHD or a CHD risk
equivalent (10-year CHD risk >20%) |
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<160 mg/dL for persons with >2 risk
factors and a 10-year CHD risk <20% |
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<190 mg/dL for persons with 0 to 1 risk factor |
In addition to weight reduction and increased
physical activity as a means of lowering TG levels, drug therapy should
be considered in high-risk individuals to achieve their non–HDL-C
goal.
Reference
| 1. |
Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol in Adults. Executive
summary of the Third Report of the National Cholesterol Education
Program (NCEP) expert panel on detection, evaluation and treatment
of high blood cholesterol in adults (Adult Treatment Panel III).
JAMA. 2001;285:2486-2497. |
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