Adult Treatment Panel III (ATP III)

Introduction

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 Program’s (NCEP’s) updated clinical guidelines for cholesterol testing and management.

Background

The third ATP report updates the existing recommendations for clinical management of high blood cholesterol. The NCEP periodically produces ATP clinical updates as warranted by advances in the science of cholesterol management. Each of the guideline reports—ATP I, II, and III—has a major thrust. ATP I outlined a strategy for primary prevention of coronary heart disease (CHD) in persons with high levels of low density lipoprotein (LDL) cholesterol (³160 mg/dL) or those with borderline-high LDL cholesterol (130-159 mg/dL) and multiple (2+) risk factors. ATP II affirmed the importance of this approach and added a new feature: the intensive management of LDL cholesterol in persons with established CHD. For CHD patients, ATP II set a new, lower LDL cholesterol goal of ²100 mg/dL. ATP III adds a call for more intensive LDL-lowering therapy in certain groups of people, in accord with recent clinical trial evidence, but its core is based on ATP I and ATP II.

Coronary Heart Disease

A narrowing of the coronary arteries, which supply blood to the heart, causes heart disease. Like any muscle, the heart needs a constant supply of oxygen and nutrients, which are carried to it by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by cholesterol and fat deposits (a process called atherosclerosis) and cannot supply enough blood to the heart, the result is coronary heart disease (CHD). If not enough oxygen-carrying blood reaches the heart, you may experience chest pain called angina. If the blood supply to a portion of the heart is completely cut off by total blockage of a coronary artery, the result is a heart attack. This is usually due to a sudden closure from a blood clot forming on top of a previous narrowing.

Cholesterol

Cholesterol is a fatty substance needed by your body in order to function. It is present in cell walls or membranes everywhere in the body, including the brain, nerves, muscle, skin, liver, intestines and heart. Cholesterol is also found in some of the foods you eat. Your body uses cholesterol to produces many hormones, vitamin D, and the bile acids that help to digest fat.

Cholesterol Blood levels

When you have high levels of cholesterol in your blood, you're at higher risk of coronary heart disease (CHD). High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high. Everyone age 20 and older should have their cholesterol levels checked at least once every 5 years. You and your doctor can discuss how often you should be tested.

Cholesterol Types

In order for cholesterol to travel in the bloodstream, it is carried in small packages called lipoproteins (lip-o-PRO-teens). The small packages are made of fat (lipid) on the inside and proteins on the outside. Two kinds of lipoproteins carry cholesterol throughout your body. It is important to have healthy levels of both:

• LDL (low density lipoprotein) cholesterol is sometimes called "bad" cholesterol. When you have a lot of LDL cholesterol in the bloodstream, there is a greater chance that too much may be deposited in artery walls, forming a cholesterol and fatty buildup (plaque) which is referred to as atherosclerosis, or "hardening of the arteries." Cholesterol buildup can prevent adequate amounts of blood from flowing to the heart and may lead to complete blockage of an artery. It is the most common cause of CHD, and happens so slowly that you are not even aware of it. The higher your LDL cholesterol, the greater your chance of this buildup.
• HDL (high density lipoprotein) cholesterol is sometimes called "good" cholesterol. When you have higher levels of HDL in your blood, it means that more high-density lipoproteins carry cholesterol away from arterial walls and to the liver. The liver then eliminates the cholesterol from the body by excreting it in the bile. The higher your HDL, the more cholesterol is eliminated and the less chance for it to accumulate in arterial walls and worsen the progression of atherosclerosis.

Measurement of Cholesterol in Blood

Cholesterol is measured as milligrams of cholesterol per deciliter of blood, which is abbreviated like this: mg/dL.

Total cholesterol doesn't equal HDL cholesterol plus LDL cholesterol. This is because there are still more types of cholesterol. Often, your total cholesterol is the only type tested. Or you may have both your total cholesterol and your HDL cholesterol tested at the same time.

If your total cholesterol is:

200 mg/dL or less	Desirable cholesterol level.
Between 200 and 239 mg/dL	Borderline-high cholesterol level.
240 mg/dL or more	Too high.

If your HDL cholesterol is:

Less than 40 mg/dL	Too low.
More than 40 mg/dL	Beneficial especially if it's above 60 mg/dL.

If you are 20 years old or older, have no heart disease and your LDL cholesterol is:

Less than 100 mg/dL	Desirable.
100 - 129 mg/dL	Near optimal/above optimal.
130 - 159 mg/dL	Borderline high.
160 - 189 mg/dL	High.
190 mg/dL and above	Very high.

If you already have CHD, then your LDL cholesterol should be 100 mg/dL or less.

Sources: Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), NIH Publication No. 01-3670 May 2001
High Blood Cholesterol, NIH Publication No. 01-3290 May 2001
Other Cholesterol resources: Cholesterol Guidelines Update