High Blood CholesterolNational Cholesterol Education Program
Third Report of the
National Cholesterol
Education Program (NCEP)
Expert Panel on
Detection
Detection,
Evaluation,
and Treatment
of High Blood
Cholesterol
in Adults
(Adult Treatment
Panel III)
Evaluation
Executive
Summary
Treatment
N A T I O N A L I N S T I T U T E S O F H E A L T H
N A T I O N A L H E A R T , L U N G , A N D B L O O D I N S T I T U T E
A

---

Discrimination Prohibited: Under provisions of
applicable public laws enacted by Congress since
1964, no person in the United States shall, on the
grounds of race, color, national origin, handicap,
or age, be excluded from participation in, be
denied the benefits of, or be subjected to discrimi-
nation under any program or activity (or, on the
basis of sex, with respect to any education program
or activity) receiving Federal financial assistance.
In addition, Executive Order 11141 prohibits
discrimination on the basis of age by contractors
and subcontractors in the performance of Federal
contracts, and Executive Order 11246 states that
no federally funded contractor may discriminate
against any employee or applicant for employment
because of race, color, religion, sex, or national
origin. Therefore, the National Heart, Lung, and
Blood Institute must be operated in compliance
with these laws and Executive Orders.
B

---

High Blood Cholesterol
Third Report of the
National Cholesterol
Education Program (NCEP)
Expert Panel on
Detection
Detection,
Evaluation,
and Treatment
of High Blood
Cholesterol
in Adults
(Adult Treatment
Panel III)
Executive
Summary
Evaluation
Treatment
National Cholesterol Education Program
National Heart, Lung, and Blood Institute
National Institutes of Health
NIH Publication No. 01-3670
May 2001

---

---

Acknowledgements
National Cholesterol Education Program Expert Panel on Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
Members:
Scott M. Grundy, M.D., Ph.D. – Chair of the Panel
Diane Becker, R.N., M.P.H., Sc.D.
Luther T. Clark, M.D.
Richard S. Cooper, M.D.
Margo A. Denke, M.D.
Wm. James Howard, M.D.
Donald B. Hunninghake, M.D.
D. Roger Illingworth, M.D., Ph.D.
Russell V. Luepker, M.D., M.S.
Patrick McBride, M.D., M.P.H.
James M. McKenney, Pharm.D.
Richard C. Pasternak, M.D., F.A.C.C.
Neil J. Stone, M.D.
Linda Van Horn, Ph.D, R.D.
Ex-officio Members:
H. Bryan Brewer, Jr., M.D.
James I. Cleeman, M.D. – Executive Director of the Panel
Nancy D. Ernst, Ph.D., R.D.
David Gordon, M.D., Ph.D.
Daniel Levy, M.D.
Basil Rifkind, M.D.
Jacques E. Rossouw, M.D.
Peter Savage, M.D.
Consultants:
Steven M. Haffner, M.D.
David G. Orloff, M.D.
Michael A. Proschan, Ph.D.
J. Sanford Schwartz, M.D.
Christopher T. Sempos, Ph.D.
Staff:
Susan T. Shero, R.N., M.S.
Elaine Z. Murray
i

---

Executive Committee Liaison and Reviewers of the Full Report
Executive Committee Liaison to the Panel:
Stephen Havas, M.D., M.P.H., M.S.
Reviewers of the Full Report of ATP III:
Eugene Braunwald, M.D., W. Virgil Brown, M.D., Alan Chait, M.D.,
James E. Dalen, M.D., Valentin Fuster, M.D., Ph.D., Henry N. Ginsberg, M.D.,
Antonio M. Gotto, M.D., D.Phil., Ronald M. Krauss, M.D.,
John C. LaRosa, M.D., F.A.C.P., Thomas H. Lee, Jr., M.D.,
Linda Meyers, Ph.D., Michael Newman, M.D., Thomas Pearson, M.D., Ph.D.,
Daniel J. Rader, M.D., Frank M. Sacks, M.D., Ernst J. Schaefer, M.D.,
Sheldon G. Sheps, M.D., Lynn A. Smaha, M.D., Ph.D., Sidney C. Smith, Jr., M.D.,
Jeremiah Stamler, M.D., Daniel Steinberg, M.D., Ph.D., Nanette K. Wenger, M.D.
National Cholesterol Education Program Coordinating Committee
The Third Report of the National Cholesterol Education Expert Panel on
Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults was
approved by the National Cholesterol Education Program Coordinating Committee,
which comprises the following organizational representatives:
Member Organizations
National Heart, Lung, and Blood Institute
Claude Lenfant, M.D. (Chair)
James I. Cleeman, M.D. (Coordinator)
American Academy of Family Physicians
Theodore G. Ganiats, M.D.
American Academy of Insurance Medicine
Gary Graham, M.D.
American Academy of Pediatrics
Ronald E. Kleinman, M.D.
American Association of Occupational Health Nurses
Pamela Hixon, B.S.N., R.N., C.O.H.N-S
American College of Cardiology
Richard C. Pasternak, M.D., F.A.C.C.
American College of Chest Physicians
Gerald T. Gau, M.D.
American College of Nutrition
Harry Preuss, M.D.
American College of Obstetricians and Gynecologists
Thomas C. Peng, M.D.
American College of Occupational and Environmental Medicine
Ruth Ann Jordan, M.D.
American College of Preventive Medicine
Lewis H. Kuller, M.D., Dr.P.H.
American Diabetes Association, Inc.
Alan J. Garber, M.D., Ph.D.
ii

---

American Dietetic Association
Linda Van Horn, Ph.D., R.D.
American Heart Association
Scott M. Grundy, M.D., Ph.D.
American Hospital Association
Sandra Cornett, R.N., Ph.D.
American Medical Association
Yank D. Coble, Jr., M.D.
American Nurses Association
To be named
American Osteopathic Association
Michael Clearfield, D.O.
American Pharmaceutical Association
James M. McKenney, Pharm.D.
American Public Health Association
Stephen Havas, M.D., M.P.H., M.S.
American Red Cross
Donald Vardell, M.S.
Association of Black Cardiologists
Karol Watson, M.D., Ph.D.
Association of State and Territorial Health Officials
Joanne Mitten, M.H.E.
Citizens for Public Action on Blood Pressure and Cholesterol, Inc.
Gerald J. Wilson, M.A., M.B.A.
National Black Nurses Association, Inc.
Linda Burnes-Bolton, Dr.P.H., R.N., M.S.N., F.A.A.N.
National Medical Association
Luther T. Clark, M.D.
Society for Nutrition Education
Darlene Lansing, M.P.H., R.D.
Society for Public Health Education
Donald O. Fedder, Dr.P.H., M.P.H.
Associate Member Organization
American Association of Office Nurses
Joyce Logan
Federal Agencies
NHLBI Ad Hoc Committee on Minority Populations
Yvonne L. Bronner, Sc.D., R.D., L.D.
Agency for Healthcare Research and Quality
Francis D. Chesley, Jr., M.D.
Centers for Disease Control and Prevention
Wayne Giles, M.D., M.P.H.
Coordinating Committee for the Community Demonstration Studies
Thomas M. Lasater, Ph.D.
iii

---

Department of Agriculture
Alanna Moshfegh, M.S., R.D.
Department of Defense
Col. Robert Dana Bradshaw, M.D., M.P.H.
Food and Drug Administration
Elizabeth Yetley, Ph.D.
Health Resources and Services Administration
Celia Hayes, M.P.H., R.D.
National Cancer Institute
Carolyn Clifford, Ph.D.
National Center for Health Statistics
Clifford Johnson, M.P.H.
Office of Disease Prevention and Health Promotion
Elizabeth Castro, Ph.D.
Department of Veterans Affairs
Pamela Steele, M.D.
iv

---

Contents
Introduction
1
Background
1
LDL Cholesterol: The Primary Target of Therapy
2
Risk Assessment: First Step in Risk Management
2
Method of risk assessment: counting major
4
risk factors and estimating 10-year CHD risk
Role of other risk factors in risk assessment
5
Metabolic syndrome
5
The link between risk assessment and cost
6
effectiveness
Primary Prevention With LDL-Lowering Therapy
6
Secondary Prevention With LDL-Lowering Therapy
7
LDL-Lowering Therapy in Three Risk Categories
7
CHD and CHD risk equivalents
8
Multiple (2+) risk factors and 10-year risk ≤20%
9
Zero to one risk factor
10
Therapeutic Lifestyle Changes in LDL-Lowering Therapy
10
Drug Therapy to Achieve LDL-Cholesterol Goals
12
Secondary prevention: drug therapy for CHD and
14
CHD risk equivalents
LDL-lowering drug therapy for primary prevention
14
Benefit Beyond LDL Lowering: The Metabolic
15
Syndrome as a Secondary Target of Therapy
Management of underlying causes of the metabolic
16
syndrome
Specific Treatment of Lipid and Non-Lipid Risk
17
Factors
Special Issues
17
Management of Specific Dyslipidemias
17
Special Considerations for Different Population Groups
20
Adherence to LDL-Lowering Therapy
22
Appendix
24
Shared Features of ATP III and ATP II
24
Estimating 10-Year Risk for Men and Women
25

---

vi

---

Document Outline

• Contents
• Acknowledgements
• Introduction
• Background
• LDL Cholesterol: The Primary Target of Therapy
• Risk Assessment: First Step in Risk Management
  • Method of risk assessment: counting major risk factors and estimating 10-year CHD risk
  • Role of other risk factors in risk assessment
  • Metabolic syndrome
  • The link between risk assessment and cost effectiveness
• Primary Prevention With LDL-Lowering Therapy
• Secondary Prevention With LDL-Lowering Therapy
• LDL-Lowering Therapy in Three Risk Categories
  • CHD and CHD risk equivalents
  • Multiple (2+) risk factors and 10-year risk €20%
  • Zero to one risk factor
• Therapeutic Lifestyle Changes in LDL-Lowering Therapy
• Drug Therapy to Achieve LDL Cholesterol Goals
  • Secondary prevention: drug therapy for CHD and CHD risk equivalents
  • LDL-lowering drug therapy for primary prevention
• Benefit Beyond LDL Lowering: The Metabolic Syndrome as a Secondary Target of Therapy
  • Management of underlying causes of the metabolic syndrome
  • Specific Treatment of Lipid and Non-Lipid Risk Factors
• Special Issues
  • Management of Specific Dyslipidemias
  • Special Considerations for Different Population Groups
  • Adherence to LDL-Lowering Therapy
• Appendix
  • Shared Features of ATP III and ATP II
  • Estimating 10-Year Risk for Men and Women

---