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Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.
Curr Opin Cardiol 2006; 21(4):400-4CO

Abstract

PURPOSE OF REVIEW

In 2001, the Adult Treatment Panel III of the National Cholesterol Education Program issued recommendations, which were updated in 2004 to reflect knowledge from five major clinical trials completed after 2001. This review discusses the results of key clinical trials released in 2005 and their potential impact on the guidelines.

RECENT FINDINGS

Three major clinical trials, one subgroup analysis, and one meta-analysis were published in 2005 that can potentially affect the existing guidelines. The Treating to New Targets and the Incremental Decrease in End Points Through Aggressive Lipid Lowering trials demonstrated the incremental benefit of more aggressive low-density cholesterol lowering in stable coronary heart disease. The Cholesterol Treatment Trialists' Collaboration meta-analysis of statin trials supported the importance of low-density lipoprotein cholesterol reduction, irrespective of initial lipid profile, in reducing cardiovascular events. A subgroup analysis of the Anglo-Scandinavian Cardiac Outcomes Trial - Lipid-Lowering Arm demonstrated statin benefits in diabetes, whereas the Fenofibrate Intervention and Event Lowering in Diabetes study failed to show overall treatment benefits with a fibrate in diabetes.

SUMMARY

Lowering of low-density lipoprotein cholesterol remains central in reducing cardiovascular risk; however, the recent trials support a target of less than 2.0 mmol/l (<80 mg/dl), rather than the less than 1.8 mmol/l (70 mg/dl) suggested by the 2004 update, for all high-risk patients and not, as recommended previously, just for those with additional factors. For individuals with diabetes, recent data support the use of statin therapy, even in those at less than high risk. First-line therapy should remain statins and not fibrates.

Authors+Show Affiliations

Division of Endocrinology and Metabolism, St. Michael's Hospital, Canada.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16755211

Citation

Cheng, Alice Yy, and Lawrence A. Leiter. "Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines." Current Opinion in Cardiology, vol. 21, no. 4, 2006, pp. 400-4.
Cheng AY, Leiter LA. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Curr Opin Cardiol. 2006;21(4):400-4.
Cheng, A. Y., & Leiter, L. A. (2006). Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Current Opinion in Cardiology, 21(4), pp. 400-4.
Cheng AY, Leiter LA. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Curr Opin Cardiol. 2006;21(4):400-4. PubMed PMID: 16755211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. AU - Cheng,Alice Yy, AU - Leiter,Lawrence A, PY - 2006/6/7/pubmed PY - 2008/1/17/medline PY - 2006/6/7/entrez SP - 400 EP - 4 JF - Current opinion in cardiology JO - Curr. Opin. Cardiol. VL - 21 IS - 4 N2 - PURPOSE OF REVIEW: In 2001, the Adult Treatment Panel III of the National Cholesterol Education Program issued recommendations, which were updated in 2004 to reflect knowledge from five major clinical trials completed after 2001. This review discusses the results of key clinical trials released in 2005 and their potential impact on the guidelines. RECENT FINDINGS: Three major clinical trials, one subgroup analysis, and one meta-analysis were published in 2005 that can potentially affect the existing guidelines. The Treating to New Targets and the Incremental Decrease in End Points Through Aggressive Lipid Lowering trials demonstrated the incremental benefit of more aggressive low-density cholesterol lowering in stable coronary heart disease. The Cholesterol Treatment Trialists' Collaboration meta-analysis of statin trials supported the importance of low-density lipoprotein cholesterol reduction, irrespective of initial lipid profile, in reducing cardiovascular events. A subgroup analysis of the Anglo-Scandinavian Cardiac Outcomes Trial - Lipid-Lowering Arm demonstrated statin benefits in diabetes, whereas the Fenofibrate Intervention and Event Lowering in Diabetes study failed to show overall treatment benefits with a fibrate in diabetes. SUMMARY: Lowering of low-density lipoprotein cholesterol remains central in reducing cardiovascular risk; however, the recent trials support a target of less than 2.0 mmol/l (<80 mg/dl), rather than the less than 1.8 mmol/l (70 mg/dl) suggested by the 2004 update, for all high-risk patients and not, as recommended previously, just for those with additional factors. For individuals with diabetes, recent data support the use of statin therapy, even in those at less than high risk. First-line therapy should remain statins and not fibrates. SN - 0268-4705 UR - https://www.unboundmedicine.com/medline/citation/16755211/Implications_of_recent_clinical_trials_for_the_National_Cholesterol_Education_Program_Adult_Treatment_Panel_III_guidelines_ L2 - http://Insights.ovid.com/pubmed?pmid=16755211 DB - PRIME DP - Unbound Medicine ER -