Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines

@article{Grundy2004ImplicationsOR,
  title={Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines},
  author={Scott M. Grundy and James I. Cleeman and C. Noel Bairey Merz and H. Bryan Jr. Brewer and Luther T. Clark and Donald B. Hunninghake and Richard C. Pasternak and Sidney C. Smith and Neil J. Stone},
  journal={Circulation: Journal of the American Heart Association},
  year={2004},
  volume={110},
  pages={227-239}
}
The Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001. Since the publication of ATP III, 5 major clinical trials of statin therapy with clinical end points have been published. These trials addressed issues that were not examined in previous clinical trials of cholesterol-lowering therapy. The present document reviews the results of these recent trials and assesses their implications for… 

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Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines
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References

SHOWING 1-10 OF 73 REFERENCES
Triglycerides and Coronary Heart Disease: Implications of Recent Clinical Trials
  • H. Rubins
  • Medicine
    Journal of cardiovascular risk
  • 2000
TLDR
The studies reviewed here suggest that patients with established coronary heart disease and a high triglyceride level, in association with either a low high-density lipoprotein-cholesterol level or perhaps other features of the metabolic syndrome, such as obesity, diabetes, or hypertension, may benefit from fibrate therapy.
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).
THE THIRD REPORT OF THE EXpert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, or ATP III) constitutes the National Cholesterol Education
Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association.
TLDR
There has been no consensus from professional societies or governmental agencies as to how these assays of markers of inflammation should be used in clinical practice, and a workshop to address these issues was convened in Atlanta, Ga.
Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial.
TLDR
For patients with coronary heart disease, intensive lipid-lowering treatment with atorvastatin reduced progression of coronary atherosclerosis compared with pravastatin.
MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Commentary
TLDR
Adding simvastatin to existing treatments safely produces substantial additional benefits for a wide range of high-risk patients, irrespective of their initial cholesterol concentrations.
Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)
TLDR
This study shows that long-term treatment with simvastatin is safe and improves survival in CHD patients, and a 37% reduction in the risk of undergoing myocardial revascularisation procedures.
Effect of Intensive Compared With Moderate Lipid-Lowering Therapy on Progression of Coronary Atherosclerosis A Randomized Controlled Trial
TLDR
For patients with coronary heart disease, intensive lipid-lowering treatment with atorvastatin reduced progression of coronary atherosclerosis compared with pravastatin.
MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trial
TLDR
Adding simvastatin to existing treatments safely produces substantial additional benefits for a wide range of high-risk patients, irrespective of their initial cholesterol concentrations.
MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial
TLDR
Direct evidence is provided that cholesterol-lowering therapy is beneficial for people with diabetes even if they do not already have manifest coronary disease or high cholesterol concentrations and statin therapy should now be considered routinely for all diabetic patients at sufficiently high risk of major vascular events, irrespective of their initial cholesterol concentrations.
Treating to New Targets (TNT) Study: does lowering low-density lipoprotein cholesterol levels below currently recommended guidelines yield incremental clinical benefit?
TLDR
The large patient numbers in the TNT study and long follow-up should ensure that there is adequate power to definitively determine if reducing LDL cholesterol levels to approximately 75 mg/dl (1.9 mmol/L) can provide additional clinical benefit.
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