Impact of Evidence-Based "Clinical Judgment" on the Number of American Adults Requiring Lipid-Lowering Therapy Based on Updated NHANES III Data

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Abstract
WHEN THE second Adult Treatment Panel (ATP II) of the US National Cholesterol Education Program published its report1,2 in 1993, data from phase 1 (1988-1991) of the third National Health and Nutrition Examination Survey (NHANES III) were used to estimate the prevalence of hypercholesterolemia as defined in the revised guidelines,3 based on the ATP II cut points for initiation of diet and drug therapy (Table 1). In addition to the cut points, however, ATP II recommends the use of "clinical judgment that weighs potential benefit, possible side effects, and costs"2(pO-8) in deciding whether to initiate drug therapy in individuals whose low-density lipoprotein cholesterol (LDL-C) level remains above goal with diet therapy but below the initiation level for drug therapy. Adult Treatment Panel II includes in this category individuals with coronary heart disease (CHD) whose LDL-C level remains at 100 to 129 mg/dL (2.59-3.35 mmol/L), individuals without CHD who have 2 or more risk factors listed in the ATP II primary prevention algorithm (Table 2) and an LDL-C level of 130 to 159 mg/dL (3.36-4.13 mmol/L), and middle-aged or older individuals without CHD who have less than 2 risk factors and an LDL-C level of 160 to 189 mg/dL (4.14-4.89 mmol/L).

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