The National Cholesterol Education Program Adult Treatment Panel II gu
idelines recommend that all adults 20 years of age and older undergo t
esting to detect dyslipoproteinemia. Clinical trials have proven concl
usively that lowering levels of low-density lipoprotein (LDL) choleste
rol reduces coronary heart disease (CHD) incidence and mortality and t
otal mortality in patients with and without CHD. There is persuasive s
cientific evidence to include young adults, women, and the elderly in
the recommendation for cholesterol management. In adults without CHD,
testing can begin with measurement of total cholesterol (TC) and high-
density lipoprotein (HDL) cholesterol in the nonfasting state, and the
results can then be used to determine which individuals require a fas
ting lipoprotein analysis (total cholesterol, HDL, triglycerides, and
estimation of LDL); patients with known CHD should begin with lipoprot
ein analysis. The level of LDL cholesterol and the presence or absence
of other CHD risk factors determine the need for cholesterol-lowering
therapy. Patients with known CHD are at highest risk for a CHD event
and have the lowest LDL cholesterol goal (100 mg/dL); patients without
CHD but with elevated LDL-C (130 mg/dL) and two or more other CHD ris
k factors are at high risk for developing CHD and have an LDL choleste
rol goal of less than 130 mg/dL; patients free of CHD with high LDL ch
olesterol (160 mg/dL) but fewer than two Other risk factors have a low
er CHD risk and an LDL cholesterol goal of less than 160 mg/dL. Elevat
ed triglyceride may be a marker for other factors that increase CHD ri
sk. Raising HDL cholesterol, while not proven to be of benefit, is rea
sonable in patients at high CHD risk.