Individuals in the denominator with LDL levels at or below the target defined by ATP III (see rationale), stratified by individual risk level: low, moderate, or high
Individuals aged 35 to 74 who had an LDL test (or a non-HDL test for those aged 35–54: at least once in the past five years; for those aged 55–74: at least once during the measurement year).
Atherosclerosis, which can lead to angina pectoris, myocardial infarction, stroke and sudden death, is a disease in which plaque accumulates inside arteries, causing them to harden and narrow over time. Achieving cholesterol target levels is important both in reducing the risk of developing heart disease among those with risk factors for this disease (primary prevention) and in preventing the progression of known heart disease (tertiary prevention). Efforts to reduce cholesterol levels include lifestyle changes and medications, including statins (1).
One of the models used to assess 10-year risk of cardiovascular disease is based on the Framingham Study. It uses a formula incorporating sex, age, total cholesterol, HDL cholesterol (a protective factor), systolic blood pressure, hypertension treatment, and smoking status. Based on this model, the adult population can be categorized as having high, moderate, or low risk. In 2001, the Adult Treatment Panel III (ATP III) published guidelines for the treatment of high blood cholesterol (2), which were updated in 2004 (3). According to these recommendations, the target LDL cholesterol levels were: for individuals at high risk (10-years risk exceeding 20%) LDL cholesterol below 100 mg/dL; for individuals at medium-risk (having more than one risk factor and their 10-years risk is lower than 20%) LDL cholesterol below 130 mg/dL; and for low-risk individuals (up to one risk factor and less than 10% risk in 10 years) the recommended level is below 160 mg/dl. It should be noted that the guidelines of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) from September 2019 have set significantly stricter targets for LDL-levels recommended for primary prevention by risk groups (4). However, the program’s current quality indicators remain unchanged in order to allow continuous comparison over time.
1. Silverman MG, Ference BA, Im K, Wiviott SD, Giugliano RP, Grundy SM, et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: A systematic review and meta-analysis. JAMA – J Am Med Assoc. 2016 Sep 27;316(12):1289–97.
2. National Cholesterol Education Program. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. 2002.
3. Grundy SM, Cleeman JI, Bairey Merz CN, Brewer HB, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Vol. 110, Circulation. 2004. p. 227–39.
4. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular riskThe Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur Heart J [Internet]. 2020 Jan 1 [cited 2023 Feb 8];41(1):111–88. Available from: https://academic.oup.com/eurheartj/article/41/1/111/5556353
