The NCEP has identified a subgroup of those individuals at high risk who are targeted as very high risk. These individuals are considered at very high risk of they already have cardiovascular disease (a previous heart attack or stroke) plus any of these additional risk factors plus diabetes, are persistent smokers, have poorly controlled high blood pressure, recently suffered a heart attack, or have metabolic syndrome – a group of risk factors that include overweight and obesity, high triglycerides, low levels of “good” high-density lipoprotein (HDL) cholesterol, high blood pressure, high blood glucose and a tendency to form blood clots.
Under guidelines issued in 2001 doctors where advised to prescribe cholesterol lowering medications along with diet and exercise therapy to lower LDL to levels of less than 100 milirams per deciliter. These new guidelines suggest even more aggressive therapy for these very high risk individuals to levels of less than 70mg/dl.
Individuals who are at moderately high risk (have not developed cardiovascular disease but have two or more risk factors the new guidelines have changed from less than 130 mg/dl to less than 100 mg/dl LDL.
The guidelines for those individuals with low to moderate risk for cardiovascular disease are unchanged.
As physicians adopt these new guidelines to their practice it is expected that the number of new prescriptions for cholesterol lowering drugs (statins) will increase substantially. The guidelines also emphasize the need for lifestyle changes to diet and activity levels. The guidelines include recommendations on eating a low-saturated fat, low-cholesterol diet; increasing fiber intake; losing weight, and exercising regularly.
