LDL-C Goal and Cut Point Levels for Therapeutic Lifestyle Changes and Drug Therapy by Risk Category, NCEP ATP III
| Risk Category | Goal mg/dL | Initiate Therapeutic Lifestyle Changesamg/dL | Drug Therapyb mg/dL |
|---|---|---|---|
| CHD = coronary heart disease; LDL-C = low-density lipoprotein cholesterol; NCEP ATP III = National Cholesterol Education Program Adult Treatment Panel III. | |||
| aPersons at high risk or moderately high risk who have lifestyle-related risk factors (eg, obesity, physical inactivity, elevated triglyceride level, low HDL-C level, or metabolic syndrome) are candidates for therapeutic lifestyle changes to modify these risk factors regardless of LDL-C level. | |||
| bLDL-C lowering drug therapy, when given, should be sufficient to reduce LDL-C levels ≥30%–40%. | |||
| cCHD includes history of myocardial infarction, unstable angina, stable angina, coronary artery procedures (angioplasty or bypass surgery), or evidence of clinically significant myocardial ischemia. | |||
| dCHD equivalents include clinical manifestations of noncoronary forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, and carotid artery disease, such as transient ischemic attacks or stroke of carotid origin or >50% obstruction of a carotid artery), diabetes, and ≥2 risk factors with a 10-year risk for hard CHD >20%. | |||
| eCHD risk factors include cigarette smoking, hypertension (blood pressure =140/90 mm Hg or taking antihypertensive medication), low high-density lipoprotein cholesterol (<40 mg/dL), family history of premature CHD (CHD in male first-degree relative aged <55 years; CHD in female first-degree relative aged <65 years), and age (men =45 years; women =55 years). Electronic 10-year risk calculators are available at http://www.nhlbi.nih.gov/guidelines/cholesterol. | |||
| fAlmost all persons with ≤1 risk factor have a 10-year risk <10%; thus, a 10-year risk assessment is unnecessary. | |||
| High: CHDc or CHD equivalentd (10-y risk >20%) | <100 | ≥100 | ≥100 (<100: consider drug options) |
| Intermediate: ≥2 risk factorsc (10-y risk ≤20%)e | <130 | ≥130 | ≥130: 10-y risk 10%-20% (100–129: consider drug options) ≥160: 10-y risk <10% |
| Low: ≤1 risk factorf | <160 | ≥160 | ≥190 (160–189: LDL-lowering drug optional) |