NIH News Release
National Heart, Lung, and Blood Institute

Tuesday, May 15, 2001
9:30 a.m. EST

Contact: NHLBI Communications Office
(301) 496-4236

NCEP Issues Major New Cholesterol Guidelines

The National Cholesterol Education Program (NCEP) today issued major new clinical practice guidelines on the prevention and management of high cholesterol in adults. The guidelines are the first major update from NCEP in nearly a decade.

NCEP, which is coordinated by the National Heart, Lung, and Blood Institute (NHLBI), develops new guidelines as warranted by research advances. Earlier guidelines were issued in 1988 and 1993.

An executive summary of the new guidelines, the "Third Report of the NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults," also known as Adult Treatment Panel (ATP) III, appears in the May 16, 2001, issue of the Journal of the American Medical Association.

Key changes in the new guidelines are: more aggressive cholesterol-lowering treatment and better identification of those at high risk for a heart attack; use of a lipoprotein profile as the first test for high cholesterol; a new level at which low HDL (high-density lipoprotein) becomes a major heart disease risk factor; a new set of "Therapeutic Lifestyle Changes," with more power to improve cholesterol levels; a sharper focus on a cluster of heart disease risk factors known as "the metabolic syndrome;" and increased attention to the treatment of high triglycerides.

The new guidelines are expected to substantially expand the number of Americans being treated for high cholesterol, including raising the number on dietary treatment from about 52 million to about 65 million and increasing the number prescribed a cholesterol-lowering drug from about 13 million to about 36 million.

"Americans at high risk for a heart attack are too often not identified and, so, don't receive sufficiently aggressive treatment," said NHLBI Director Dr. Claude Lenfant. "Yet, studies show conclusively that lowering the level of low-density lipoprotein, or LDL, the 'bad cholesterol,' can reduce the short-term risk for heart disease by as much as 40 percent. Treatment may lower risk over the long-term — that beyond 10 years — even more. That's why, while the intensity of treatment in ATP III is stepped up, its primary aim remains squarely on lowering LDL."

According to ATP III, Americans at high risk for a heart attack include those with heart disease or diabetes, and many of those with multiple heart disease risk factors. The guidelines state that diabetes poses as great a risk for having a heart attack in 10 years as heart disease itself-and the threat from multiple risk factors can be equally great. The guidelines recommend these persons be treated as intensively as heart disease patients with lifestyle changes and medication.

To better identify risk, the guidelines include a tool that predicts a person's chance of having a heart attack within 10 years. Based on newly analyzed data from the landmark, NHLBI-supported Framingham Heart Study, the "risk assessment tool" translates clinical conditions and lifestyle factors into a single, easy-to-understand category of risk. The tool calculates risk separately for men and women based on age, total cholesterol, HDL (the "good" cholesterol), systolic blood pressure, treatment for high blood pressure, and cigarette smoking. ATP III recommends use of the tool for persons with two or more heart disease risk factors.

"The new guidelines will help doctors determine heart attack risk more precisely than was possible before," said Dr. Scott Grundy, ATP III chairperson and director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas. "That allows treatment to be more individualized. We now know that cholesterol-lowering treatment is more effective when its intensity closely matches the level of risk."

"The ATP III approach looks at 'overall' risk for a heart attack," said NCEP Coordinator Dr. James Cleeman, "which means in the short- and long-term. That's important because, although risk typically increases with age, the foundation for heart disease is often laid in adolescence and early adulthood. So Americans need to act now to prevent that future heart attack or heart disease itself. Every risk factor needs to be treated."

Cleeman advises Americans to check with their doctor to learn their overall risk for a heart attack and what, if any, treatment is needed.

Other changes in the new guidelines include:

Founded in 1985, NCEP seeks to reduce the prevalence of high blood cholesterol among Americans. It is a multidisciplinary coalition with a Coordinating Committee comprised of representatives from more than 40 major medical and health professional associations, voluntary health organizations, community programs, and governmental agencies.

The new guidelines were developed over 20 months by 27 panel members and consultants who are leading experts in heart disease, lipid measurement and management, primary care medicine, nutrition, epidemiology, health economics, and other areas. The guidelines were reviewed and approved by NCEP's Coordinating Committee.

NHLBI is part of the National Institutes of Health, located in Bethesda, MD.

To arrange an interview with Cleeman, contact the NHLBI Communications Office at (301) 496-4236. Also available from the NHLBI Communications Office is a b-roll with soundbites. There will be the following satellite feeds of the b-roll: May 15, 2001, 2 p.m. to 2:15 p.m. Eastern, Telstar 4, Transponder 6, DL 3820, C-Band; May 16, 2001, 1:15 p.m. to 1:30 p.m. Eastern, Telstar 5, Transponder 16, DL 4020, C-Band.

To interview Grundy, contact Amy Shields, University of Texas Southwestern Medical Center's Office of News and Publications, at (214) 648-3404.

The following ATP III and cholesterol-related materials can be found online: The guidelines' executive summary and "At A Glance" desk reference for physicians; an interactive version of the guidelines for PalmOS devices; a patient brochure, "High Blood Cholesterol-What You Need To Know;" a 10-year heart attack risk calculator; and a "Live Healthier, Live Longer" Web site for patients and the public. To get these items, go to the NHLBI home page at and click on ATP III Cholesterol Guidelines under Highlights.