ATPIII官方（NCEP&NHLBI）正式版幻灯，共10个部分，103张。
Adult Treatment Panel III (ATP III) Guidelines
National Cholesterol Education Program
Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (ATP III)
Members
Scott M. Grundy, M.D., Ph.D. (Chair)
University of Texas Southwestern Medical Center at Dallas
Diane Becker, Sc.D., M.P.H.
The Johns Hopkins University
Luther T. Clark, M.D.
State University of New York, Brooklyn
Richard S. Cooper, M.D.
Loyola University Medical School
Margo A. Denke, M.D.
University of Texas Southwestern Medical Center at Dallas
Wm. James Howard, M.D.
Washington Hospital Center
Donald B. Hunninghake, M.D.
University of Minnesota
D. Roger Illingworth, M.D., Ph.D.
The Oregon Health Sciences University
Russell V. Luepker, M.D., M.S.
University of Minnesota
Patrick McBride, M.D., M.P.H.
University of Wisconsin Hospital and Clinics
James M. McKenney, Pharm.D.
National Clinical Research
Richard C. Pasternak, M.D., F.A.C.C.
Massachusetts General Hospital
Neil J. Stone, M.D.
Northwestern University School of Medicine
Linda Van Horn, Ph.D, R.D.
Northwestern University Medical School
Ex-Officio Members
H. Bryan Brewer, Jr., M.D.
National Heart, Lung, and Blood Institute
James I. Cleeman, M.D. (Executive Director)
National Heart, Lung, and Blood Institute
Nancy D. Ernst, Ph.D., R.D.
National Heart, Lung, and Blood Institute
David Gordon, M.D., Ph.D.
National Heart, Lung, and Blood Institute
Daniel Levy, M.D.
National Heart, Lung, and Blood Institute
Basil Rifkind, M.D.
National Heart, Lung, and Blood Institute
Jacques E. Rossouw, M.D.
National Heart, Lung, and Blood Institute
Peter Savage, M.D.
National Heart, Lung, and Blood Institute
Consultants
Steven M. Haffner, M.D.
University of Texas Health Science Center, San Antonio
David G. Orloff, M.D.
Food and Drug Administration
Michael A. Proschan, Ph.D.
National Heart, Lung, and Blood Institute
J. Sanford Schwartz, M.D.
University of Pennsylvania
Christopher T. Sempos, Ph.D.
State University of New York, Buffalo
National Cholesterol Education Program Coordinating Committee
Agency for Healthcare Research and Quality
American Academy of Family Physicians
American Academy of Insurance Medicine
American Academy of Pediatrics
American Association of Occupational Health Nurses
American Association of Office Nurses
American College of Cardiology
American College of Chest Physicians
American College of Nutrition
American College of Obstetricians and Gynecologists
American College of Occupational and Environmental Medicine
American College of Preventive Medicine
American Diabetes Association, Inc.
American Dietetic Association
American Heart Association
American Hospital Association
American Medical Association
American Nurses Association
American Osteopathic Association
American Pharmaceutical Association
American Public Health Association
American Red Cross
Association of Black Cardiologists
Association of State and Territorial Health Officials
Centers for Disease Control and Prevention
Citizens for Public Action on Blood Pressure and Cholesterol, Inc.
Coordinating Committee for the Community Demonstration Studies
Health Resources and Services Administration
National Black Nurses Association, Inc.
National Cancer Institute
National Center for Health Statistics
National Heart, Lung, and Blood Institute
National Medical Association
NHLBI Ad Hoc Committee on Minority Populations
Office of Disease Prevention and Health Promotion
Society for Nutrition Education
Society for Public Health Education
U.S. Department of Agriculture
U.S. Department of Defense
U.S. Department of Veterans Affairs (VA)
U.S. Food and Drug Administration
National Cholesterol Education Program Reports
Adult Treatment Panel I (1988) Adult Treatment Panel II (1993) Adult Treatment Panel III (2001)
Recommendations for Improving Cholesterol Measurement (1990) Recommendations on Lipoprotein Measurement (1995)
Population Strategies for Blood Cholesterol Reduction (1990)
Blood Cholesterol Levels in Children and Adolescents (1991)
New Features of ATP III
Focus on Multiple Risk Factors
Diabetes: CHD risk equivalent
Framingham projections of 10-year CHD risk
Identify certain patients with multiple risk factors for more intensive treatment
Multiple metabolic risk factors (metabolic syndrome)
Intensified therapeutic lifestyle changes
New Features of ATP III (continued)
Modification of Lipid and Lipoprotein Classification
LDL cholesterol <100 mg/dL—optimal
HDL cholesterol <40 mg/dL
Categorical risk factor
Raised from <35 mg/dL
Lower triglyceride classification cut points
More attention to moderate elevations
New Features of ATP III (continued)
New Recommendation for Screening/Detection
Complete lipoprotein profile preferred
Fasting total cholesterol, LDL, HDL, triglycerides
Secondary option
Non-fasting total cholesterol and HDL
Proceed to lipoprotein profile if TC ?200 mg/dL or HDL <40 mg/dL
New Features of ATP III (continued)
Therapeutic diet lowers saturated fat and cholesterol intakes to levels of previous Step II
Adds dietary options to enhance LDL lowering
Plant stanols/sterols (2 g/d)
Viscous (soluble) fiber (10–25 g/d)
Increased emphasis on weight management and physical activity
More Intensive Lifestyle Intervention (Therapeutic Lifestyle Changes = TLC)
New Features of ATP III (continued)
New strategies for Promoting Adherence
In both:
Therapeutic Lifestyle Changes (TLC)
Drug therapies
New Features of ATP III (continued)
For patients with triglycerides ?200 mg/dL
LDL cholesterol: primary target of therapy
Non-HDL cholesterol: secondary target of therapy
Non HDL-C = total cholesterol – HDL cholesterol
Cost-Effectiveness Issues
Therapeutic lifestyle changes (TLC)
Most cost-effective therapy
Drug therapy
Dominant factor affecting costs
Cost effectiveness: one factor in the decision for drug therapy
Declining price of drugs: increases cost effectiveness
ATP III Guidelines Detection and Evaluation
Categories of Risk Factors
Major, independent risk factors
Life-habit risk factors
Emerging risk factors
Life-Habit Risk Factors
Obesity (BMI ? 30)
Physical inactivity
Atherogenic diet