Elsevier Pathology

Clinical Pathology: Clinical Chemistry

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• The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines identify major risk factors for coronary heart disease (CHD) that modify the goal for low-density lipoprotein (LDL) cholesterol. Diabetes mellitus is now considered a risk equivalent because it confers a high risk for new CHD within 10 years. This means that for evaluation of elevated cholesterol levels, diabetic patients are treated like patients who already have CHD. Also, ATP III recognized patients with metabolic syndrome and patients with a high 10-year risk for CHD based on the Framingham risk projections as candidates for intensive intervention and therapy.

LDL Cholesterol ATP III Classification
<100 Optimal
100–129 Near optimal/above optimal
130–159 Borderline high
160–189 High
>190 Very high
Total Cholesterol
<200 Desirable
200–239 Borderline high
≥240 High
HDL Cholesterol
<40 Low
≥60 High
Triglycerides
<150 Normal
150–199 Borderline high
200–499 High
≥500 Very high

•

Risk Category LDL Goal (mg/dL)
CHD and CHD risk equivalents <100
Multiple (2+) risk factors <130
0 to 1 risk factor <160

LDL cholesterol goal for multiple risk factors with a 10-year CHD risk >20% is <100 mg/dL.
National Cholesterol Education Program Expert Panel. 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): final report.Circulation 2002;106:3143–3421.

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