Low density lipoprotein classification: Difference between revisions
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==Overview== | ==Overview== | ||
Prior approaches to the management of LDL aimed towards the classification of LDL concentrations and the treatment of subjects with [[dyslipidemia]] to a target LDL concentration. In 2001, the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III classified LDL concentrations into optimal, near optimal, borderline high, high, and very high.<ref name="pmid11368702">{{cite journal| author=Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults| title=Executive Summary of The 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). | journal=JAMA | year= 2001 | volume= 285 | issue= 19 | pages= 2486-97 | pmid=11368702 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11368702 }} </ref> However, the latest 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults no longer takes into consideration LDL cut-off concentration but rather identifies groups of patients among whom the benefit of statin outweighs the risk of adverse events.<ref name="pmid24239923">{{cite journal| author=Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH et al.| title=2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 25 Pt B | pages= 2889-934 | pmid=24239923 | doi=10.1016/j.jacc.2013.11.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24239923 }} </ref> | |||
==Classification== | ==Classification== | ||
{| | ===Classification of the Different Concentrations of LDL=== | ||
Shown below is the classification of the different concentrations of LDL according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III published in 2001.<ref name="pmid11368702">{{cite journal| author=Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults| title=Executive Summary of The 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). | journal=JAMA | year= 2001 | volume= 285 | issue= 19 | pages= 2486-97 | pmid=11368702 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11368702 }} </ref> | |||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Concentration mg/dL'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center | '''Concentration mmol/L''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Interpretation''' | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |<100 | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |<2.6 | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Optimal | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |100 to 129 | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |2.6 to 3.3 | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Near optimal | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |130 to 159 | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |3.3 to 4.1 | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Borderline high | |||
|- | |- | ||
| | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |160 to 189 | ||
| | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |4.1 to 4.9 | ||
| | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |High | ||
|- | |- | ||
| 100 to | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |>190 | ||
| | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |>4.9 | ||
| | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |Very high | ||
|} | |||
===Classification of Statin Benefit Groups=== | |||
The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults no longer takes into consideration LDL cut-off concentration but rather identifies groups of patients among whom the benefit of [[statin]] outweighs the risk of adverse events. Shown below is the classification of the four statin benefit groups.<ref name="pmid24239923">{{cite journal| author=Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH et al.| title=2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 25 Pt B | pages= 2889-934 | pmid=24239923 | doi=10.1016/j.jacc.2013.11.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24239923 }} </ref> | |||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |- | ||
| | | style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Statin benefit groups''' | ||
| | |||
|- | |- | ||
| | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |1- Presence of [[atherosclerotic]] cardiovascular disease, defined as prior [[acute coronary syndrome]], [[stable angina|stable]] or [[unstable angina]], coronary revascularization, non coronary arterial revascularization, [[stroke]], [[transient ischemic attack]], or [[peripheral artery disease]] | ||
| | |||
| | |||
|- | |- | ||
| | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |2- LDL ≥ 190 mg/dL | ||
| | |- | ||
| | | style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |3- [[Diabetes mellitus]] PLUS age 40-75 years PLUS LDL 10-189 mg/dL | ||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |4- LDL 70-189 PLUS estimated 10 year risk of atherosclerotic cardiovascular disease ≥ 7.5% | |||
|} | |} | ||
The estimated 10 year risk of atherosclerotic cardiovascular disease should be calculated every 4 to 6 years using the pooled cohort equation.<ref name="pmid24239923">{{cite journal| author=Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH et al.| title=2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 25 Pt B | pages= 2889-934 | pmid=24239923 | doi=10.1016/j.jacc.2013.11.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24239923 }} </ref> | |||
==References== | ==References== | ||
Latest revision as of 00:07, 29 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Prior approaches to the management of LDL aimed towards the classification of LDL concentrations and the treatment of subjects with dyslipidemia to a target LDL concentration. In 2001, the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III classified LDL concentrations into optimal, near optimal, borderline high, high, and very high.[1] However, the latest 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults no longer takes into consideration LDL cut-off concentration but rather identifies groups of patients among whom the benefit of statin outweighs the risk of adverse events.[2]
Classification
Classification of the Different Concentrations of LDL
Shown below is the classification of the different concentrations of LDL according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III published in 2001.[1]
| Concentration mg/dL | Concentration mmol/L | Interpretation |
| <100 | <2.6 | Optimal |
| 100 to 129 | 2.6 to 3.3 | Near optimal |
| 130 to 159 | 3.3 to 4.1 | Borderline high |
| 160 to 189 | 4.1 to 4.9 | High |
| >190 | >4.9 | Very high |
Classification of Statin Benefit Groups
The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults no longer takes into consideration LDL cut-off concentration but rather identifies groups of patients among whom the benefit of statin outweighs the risk of adverse events. Shown below is the classification of the four statin benefit groups.[2]
| Statin benefit groups |
| 1- Presence of atherosclerotic cardiovascular disease, defined as prior acute coronary syndrome, stable or unstable angina, coronary revascularization, non coronary arterial revascularization, stroke, transient ischemic attack, or peripheral artery disease |
| 2- LDL ≥ 190 mg/dL |
| 3- Diabetes mellitus PLUS age 40-75 years PLUS LDL 10-189 mg/dL |
| 4- LDL 70-189 PLUS estimated 10 year risk of atherosclerotic cardiovascular disease ≥ 7.5% |
The estimated 10 year risk of atherosclerotic cardiovascular disease should be calculated every 4 to 6 years using the pooled cohort equation.[2]
References
- ↑ 1.0 1.1 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001). "Executive Summary of The 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)". JAMA. 285 (19): 2486–97. PMID 11368702.
- ↑ 2.0 2.1 2.2 Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH; et al. (2014). "2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 63 (25 Pt B): 2889–934. doi:10.1016/j.jacc.2013.11.002. PMID 24239923.