Author + information
- Received November 3, 2009
- Revision received November 25, 2009
- Accepted November 30, 2009
- Published online August 17, 2010.
- James S. Forrester, MD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. James S. Forrester, Department of Cardiology, Cedars-Sinai Medical Center, 24172 Malibu Road, Los Angeles, California 90265-4911
The new Adult Treatment Panel guidelines will be published in 2011. This paper suggests the consideration of major changes in the existing management guidelines for low-density lipoprotein cholesterol management based on 2 fundamental principles: return the low-density lipoprotein cholesterol level to the normal range and begin treatment closer to disease onset. These principles suggest the value of rethinking all 3 of the principal features of the Adult Treatment Panel III guidelines for low-density lipoprotein cholesterol management: the initiation criteria, the use of variable targets, and the level of the treatment target. Because the principal issue surrounding guideline change is likely to be uncertainty concerning cost and toxicity, the text of new guidelines would have to completely satisfy this concern by strong emphasis on a prudent conservative approach to implementation and would include both cautionary data and caveats concerning the tradeoffs between the potency, cost, and toxicity of statins. The proposed changes in the guidelines, if combined with effective implementation, would likely lead to the displacement of atherosclerotic disease as the nation's number 1 killer. This review provides a logical rationale and discusses the pros and cons for each of the proposed changes.
- Adult Treatment Panel III
- coronary artery disease prevention
- low-density lipoprotein cholesterol
- National Cholesterol Education Program guidelines
Dr. Forrester has received Speakers' Bureau honoraria in the past 2 years from Merck, Pfizer, AstraZeneca, Bristol-Myers Squibb, Berkeley Heart Lab, Sanofi-Aventis, and St. Jude Medical.
- Received November 3, 2009.
- Revision received November 25, 2009.
- Accepted November 30, 2009.
- American College of Cardiology Foundation
- The Asymptomatic Population as a Putative Normal
- Defining Putative Normal From Nonatherosclerotic Populations
- Testing a Putative Normal Range of LDL-C in Humans
- Insights Derived From New Lifetime Follow-Up Data
- Implications for Recommendations and Guidelines
- Rethinking Initiation Criteria
- Rethinking the LDL-C Target
- Controlling the Potential Major Expansion in Statin Use
- Arguing the Case for and Against Rethinking the Approach to LDL-C Management