NCEP ATP IV GUIDELINES: 2013 UPDATE Kerry Haney, PharmD, BCACP,
CPP UM Skaggs School of Pharmacy 1/12/13 Slide 2 Learning
Objectives 1. List three anticipated changes to the ATP IV
guidelines 2. Compare and contrast two validated risk assessment
tools used to stratify risk of developing cardiovascular disease
and individualize LDL-c goals 3. Describe the primary treatment
targets from the ATP III guidelines and potential changes for ATP
IV Slide 3 National Cholesterol Education Program (NCEP) Adult
Treatment Panel (ATP) Guidelines U.S. guidelines for the detection,
evaluation, and treatment of hyperlipidemia in adults Developed by
an expert panel for the National Heart, Lung, and Blood Institute
(NHLBI) Division of National Institutes of Health (NIH) Long
history of developing clinical practice guidelines First JNC report
published 1976 ATP release history: ATP I First released in 1988
ATP II 1993 ATP III 2001 Slide 4 For more information or to check
status: http://www.nhlbi.nih.gov/guidelines/indevelop.htm Slide 5
Potential Changes for ATP IV Current guidelines ATP III Focus on
LDL-c Greatest intensity of treatment for patients at highest risk
Other dyslipidemia management guidelines Changes in LDL-c targets
for those at highest risk Some modifications of risk factors
Direction from expert panel for ATP IV Critical questions
Scientific evidence from clinical trials Slide 6 U.S. Guidelines
for Management of Dyslipidemias 2001NCEP ATP III guidelines
2004NCEP ATP III implications 2008ADA/ACCF Consensus Statement on
Lipoprotein Management in Patients with Cardiometabolic Risk
2011AHA/ACC guidelines for secondary prevention 2012 AACE
Guidelines for the Management of Dyslipidemia and Prevention of
Atherosclerosis 2013ADA Standards of Medical Care in DM AACE =
American Association of Clinical Endocrinologists, ACC = American
College of Cardiology, ACCF = American College of Cardiology
Foundation, ADA = American Diabetes Association, AHA= American
Heart Association Slide 7 Critical Questions for ATP IV What
evidence supports LDL-c goals for secondary prevention? What
evidence supports LDL-c goals for primary prevention? What is the
impact of the major cholesterol drugs on efficacy/safety in the
populations? Slide 8 Slide 9 Overview of Potential Changes for ATP
IV Modification of CVD Risk Estimation Adjustment of major risk
factors and CHD risk equivalents Alternative risk assessment tool
to Framingham Risk Score (FRS) Changes in Treatment Targets Changes
in LDL-c goals More aggressive treatments in those at elevated risk
of CHD Changes in target emphasis Recommended Pharmacologic
Treatment Continued use of statins at optimal dosing Highlight lack
of CV outcome evidence for adjunctive therapies Slide 10 Slide 11
ATP III Classification of Cholesterol Concentrations
LipoproteinConcentration (mg/dL)Interpretation TC< 200 200-239
240 Desirable Borderline high High LDL-c Slide 12 ATP III Treatment
Targets Exception: TG lowering is an immediate target if 500 mg/dL
Primary Target: LDL-c Secondary Target: Non-HDL-c (Once LDL goal
met and if TG 200) Slide 13 NCEP ATP III: Determining LDL-c Goals
Yes No Presence of ASVD, DM High-Risk: 20%10-20% Potential Change
for ATP IV CHD Risk Equivalents Chronic kidney disease (CKD)
Potentially added as a CHD risk equivalent Increased risk of CHD
and premature CHD Evidence suggests patients with CKD have expected
10-yr risk CHD > 20% Guidelines National Kidney Foundation (NKF)
Kidney Disease Outcomes Quality Initiative (K/DOQI) Group 2003 AHA
supported recommendation 2003 Slide 16 NCEP ATP III: Determining
LDL-c Goals Yes No Presence of ASVD, DM High-Risk: 20%10-20% NCEP
ATP III: Determining LDL-c Goals Yes No Presence of ASVD, DM
High-Risk: 20%10-20% NCEP ATP III: Determining LDL-c Goals Yes No
Presence of ASVD, DM High-Risk: 20%10-20%
