ABSTRACT
The predictive relation between plasma cholesterol and coronary heart disease (CHD) has been well established by numerous observational and clinical trials. The concept of risk factors, introduced by the Framingham Heart Study more than 50 years ago, serves as the ‘gold standard’ in risk assessment for CHD. The major risk factors account for over 80% of excess risk for premature CHD according to follow-up data from the Multiple Risk Factor Intervention Trial (MRFIT).1 The findings from Framingham have contributed greatly to the recommendations for CHD prevention published by the National Cholesterol Education Program (NCEP).2 In May 2001, the National Heart, Lung and Blood Institute (Bethesda, MD) released updated cholesterol guidelines for the adult US population, and simultaneously, the executive summary of the Adult Treatment Panel III (ATP III) was published in the Journal of the American Medical Association. This report updated clinical guidelines for cholesterol testing and management and is the most recent component of the NCEP. Two previous panels have issued guidelines for adult treatment, and other panels of the NCEP have previously issued reports detailing other aspects of cholesterol measurement and management (including population recommendations, laboratory guidelines and standards for the treatment of children and adolescents). Also, since the first Joint European Societies-European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension-Task Force recommendations on CHD prevention in clinical practice were published in 1994 new scientific evidence has emerged in both primary and secondary coronary prevention, particularly in relation to lipid-lowering therapy. Therefore, a second Task Force was convened by the three major societies, including professional representatives from behavioural medicine, primary care and the European Heart Network, to revise the recommendations, which were published in 1998.3
‘Expert’ groups in the USA and Europe have issued hundreds of guidelines in the last century. For decades, these publications found themselves gathering dust on shelves or quickly discarded. Only over the last one to two decades have clinical guidelines increasingly become part of the daily life of practising clinicians. The importance of such guidelines can be tracked to at least two concurrent developments: increasing attention to the practice of what is called evidence-based medicine and the increasing complexity of contemporary medical management. With regard to the latter, lipid management is no exception.
