National Cholesterol Education Program - Essay Example

Additional factors include age, a family history of heart disease, and being male. The risk of heart disease is the main reason why cholesterol level alertness is required. Heart disease, also known as cardiovascular disease (CVD) or coronary heart disease (CHD), is defined as any disorder, which impairs the normal functioning of the heart (Gandelman, 2006). Such disorders include arrhythmias, heart attack (myocardial infarction), and the various kinds of cardiomyopathy and angina. According to Barrett (2006), heart attack is ranked one among the most common causes of death in the United States and stroke is a close third.

Epidemiological surveys demonstrated that there is a continuous correlation between CHD risk and serum total cholesterol levels over a broad range of cholesterol values (Grundy et al., 2004). High-risk and very high-risk people are individuals who have over 20% chance of heart attack within ten years (Barrett, 2006). The 2004 ATP III guideline regarding the said individuals state that drug therapy should be definite at 130 mg/dL (milligram per deciliter) cholesterol levels and it should be optional between 100 to 129 mg/dL levels (Barrett, 2006).

This was a major change from the 2001 recommendation. Now, the goal for LDL-lowering therapy for all high-risk patients is a LDL-C level of less than 100 mg/dL (Grundy et al., 2004). According . The ATP reports identified low-density lipoprotein cholesterol (LDL-C) as the main target of cholesterol-lowering therapy since "Many prospective studies have shown that the high serum concentrations of LDL-C is a major risk factor for coronary heart disease (CHD)" (Grundy et al., 2004). Cholesterol-lowering therapy involves statins and some clinical trials that tested the efficiency and effectiveness of these drugs are as follows.

In a Heart Protection Study (HPS) conducted in the United Kingdom involving 20 536 adults, aged 40 to 80 years and at high risk for a CVD event, the patients were randomly allocated to 40 mg simvastatin or placebo daily (Grundy et al., 2004). The results demonstrated that in patients treated with simvastatin, all-cause mortality was significantly reduced by 13%. Moreover, "Major vascular events were reduced by 24%, coronary death rate by 18%, nonfatal myocardial infarction + coronary death by 27%, nonfatal or fatal stroke by 25%, and cardiovascular revascularization by 24%" (Grundy et al., 2004). On the other hand, the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) examined the efficacy of pravastatin treatment in older people with or at high risk of developing CVD and stroke.

A total of 5804 subjects aged 70 to 82 years, with history of vascular disease or CVD risk factors, were randomly assigned pravastatin or placebo treatment. The follow-up averaged 3.2 years. Results showed that baseline total cholesterol ranged from 150 mg/dL to 350 mg/dL and prasvatatin reduced LDL-C levels by 34%. Major coronary events such as nonfatal myocardial infarction and CHD death fell by 19% whereas CHD mortality fell by 24%. The authors of PROSPER concluded that statin therapy can be extended to