A COMPARISON BETWEEN NCEP ATP III AND THE 2013 ACC/AHA LIPID GUIDELINES

1. Dr Subhasish Deb
Burdwan Medical College and Hospital
Department of General Medicine
2013 ACC/AHA BLOOD
CHOLESTEROL
GUIDELINES
Dr Subhasish Deb, BMCH

2. Dr Subhasish Deb, BMCH

3. No LDL targets
Only STATINS to be used
Identification of 4 groups to benefit from
statin
-only considers high quality RCT data
THE CRUX
Dr Subhasish Deb, BMCH

4. LDL TARGETS
(NCEP ATP III)
Dr Subhasish Deb, BMCH

5. Dr Subhasish Deb, BMCH

6. 1. Cigarette smoking
2. HTN (BP>=140/90 or on medication)
3. Low HDL-C (<40mg/dl)
4. Family history of premature CHD
a) CHD in male 1` relative <55yrs
b) CHD in female 1` relative <65yrs
5. Age : Men>=45yrs, Women >=55yrs
HDL>=60mg/dl counts as a negative risk factor. Its
presence removes 1 risk factor from total count
MAJOR RISK FACTORS IN NCEP ATP III
Dr Subhasish Deb, BMCH

7. Dr Subhasish Deb, BMCH

8. ACC/AHA
Statin benefit groups
Dr Subhasish Deb, BMCH

9. GROUP 1
Pts with clinical ASCVD
(ACS, h/o MI, stable angina,
Stroke, PVD of atherosclerotic
Orign)
GROUP 2
GROUP 3 GROUP 4
LDL >=190 mg/dl
• LDL 70-189mg/dl
• Age 45-75yrs
• Diabetic
• LDL 70-189mg/dl
• Age 45-75yrs
• 10yr ASCVD
Risk >=7.5 %
High Intensity Statins High Intensity Statins
Moderate Intensity Statins Moderate Intensity Statins
EXCEPTION: Moderate Intensity if AGE >75yrs
EXCEPTION: High Intensity if
ASCVD>7.5% Dr Subhasish Deb, BMCH

10. Dr Subhasish Deb, BMCH

11. Dr Subhasish Deb, BMCH

12. NYHA II- IV ischemic systolic
Heart Failure
Pts. On maintenance
hemodialysis
WHEN NOT TO “STATINZE”
Dr Subhasish Deb, BMCH

13. SAFETY
RECOMMENDATIONS
FOR STATIN USE
Dr Subhasish Deb, BMCH

14. Dr Subhasish Deb, BMCH

15. Dr Subhasish Deb, BMCH

16. Dr Subhasish Deb, BMCH

17. Mr. Mondal, 54yr old, smoker on Tab
amlodipine 10 o.d had hemiplegia on right side.
His lipid profile shows:
Cholesterol 268
Trig 168
Hdl 35
Ldl 142
CASE 1
HIGH INTENSITY STATIN
Dr Subhasish Deb, BMCH

18. Mrs Rehima Bibi, 34yr old non smoker on
amlodipine 5 and tab prazosin 5, grade V ckd
on H/d.
Cholesterol 268
Trig 168
Hdl 35
Ldl 198
CASE 2
NO STATIN
Dr Subhasish Deb, BMCH

19. 48yrs old Mr. JD, non smoker non htn, on
metformin 500 b.d lipid profile shows:
Cholesterol 238
Trig 198
Hdl 30
Ldl 158
CASE 3
MODRATE INTENSITY
Dr Subhasish Deb, BMCH

20. Mr Roy, 50yrs smoker, alcoholic, BP= 150/90
with:
Cholesterol 238
Trig 198
Hdl 30
Ldl 158
CASE 4
MODERATE INTENSITY STATIN
Ascvd Risk = 32.1%
Dr Subhasish Deb, BMCH

21. Thank YouTHANK YOU
Dr Subhasish Deb, BMCH