The decision regarding when to prescribe medications for high cholesterol levels could hardly be more important. Nearly 1 million Americans die of cardiovascular disease every year, and billions of dollars are spent on cholesterol medications every year to prevent its occurrence and consequences. In 1985, the National Heart, Lung, and Blood Institute launched the National Cholesterol Education Program (NCEP) with the goal of reducing the burden of illness and death due to high cholesterol levels. Since that time, the NCEP has convened an Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (the “Adult Treatment Panel”) 3 times, most recently in 2001 (NCEP-ATP III).1 A basic tenet of NCEP-ATP III guidelines is that patients with higher coronary heart disease (CHD) risk should receive more aggressive lipid-lowering therapy, and NCEP-ATP III recommends explicit calculation of CHD risk using the standard Framingham risk factors (age, sex, blood pressure, cholesterol, diabetes, and smoking), at least for patients with more than 1 standard risk factor.1
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