Implications from the air force/texas coronary atherosclerosis prevention study for the adult treatment panel III guidelines

Michael Clearfield, John R Downs, Michael Lee, Alex Langendorfer, Walter McConathy, Antonio M. Gotto

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) first reported its results in 1998, before the 2001 publication of the National Cholesterol Education Program-Adult Treatment Panel III guidelines (NCEP-ATP III) and 2004 update. Our objective was to investigate the impact of these guidelines on the AFCAPS/TexCAPS cohort. The main outcome measures were the event rates of first acute major coronary events (AMCEs), which were reduced 39% by lovastatin (95% confidence interval [CI] 21% to 53%, p <0.001) in the 65% of the cohort eligible for drug therapy and by 34% (95% CI -9% to 60%, p = 0.108) in the remaining 35% for whom drug therapy was considered optional. The evaluation of other guideline components included a 44% (95% CI 27% to 58%, p <0.001) reduction in AMCEs in subjects with baseline high-density lipoprotein cholesterol <40 mg/dl and a 41% (95% CI 19% to 57%) reduction in AMCEs in subjects with the metabolic syndrome. In the recent update, patients who had a moderately high risk of coronary heart disease and a baseline low-density lipoprotein cholesterol level of 100 to 130 mg/dl could be considered for therapy with a medication to lower the low-density lipoprotein cholesterol level to <100 mg/dl. A total of 334 subjects (5.1%) were in this group, in whom lovastatin reduced the risk of AMCEs by 68% (95% CI 12% to 88%, p = 0.027). However, 21% of the AMCEs were missed by the guidelines. Metabolic syndrome was noted in 48% of these subjects and may help define those in whom treatment with a medication is now considered optional. In conclusion, the ability of the ATP III guidelines and its update has markedly improved our ability to define coronary heart disease risk; however, other components of the guidelines, such as non-high-density lipoprotein cholesterol and the optional low-density lipoprotein cholesterol target goal of <100 mg/dl, still require additional evaluation.

Original languageEnglish (US)
Pages (from-to)1674-1680
Number of pages7
JournalAmerican Journal of Cardiology
Volume96
Issue number12
DOIs
StatePublished - Dec 15 2005
Externally publishedYes

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Coronary Artery Disease
Air
Guidelines
Confidence Intervals
LDL Cholesterol
Lovastatin
Coronary Disease
Therapeutics
Drug Therapy
HDL Cholesterol
Publications
Adenosine Triphosphate
Cholesterol
Outcome Assessment (Health Care)
Education

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Implications from the air force/texas coronary atherosclerosis prevention study for the adult treatment panel III guidelines. / Clearfield, Michael; Downs, John R; Lee, Michael; Langendorfer, Alex; McConathy, Walter; Gotto, Antonio M.

In: American Journal of Cardiology, Vol. 96, No. 12, 15.12.2005, p. 1674-1680.

Research output: Contribution to journalArticle

Clearfield, Michael ; Downs, John R ; Lee, Michael ; Langendorfer, Alex ; McConathy, Walter ; Gotto, Antonio M. / Implications from the air force/texas coronary atherosclerosis prevention study for the adult treatment panel III guidelines. In: American Journal of Cardiology. 2005 ; Vol. 96, No. 12. pp. 1674-1680.
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abstract = "The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) first reported its results in 1998, before the 2001 publication of the National Cholesterol Education Program-Adult Treatment Panel III guidelines (NCEP-ATP III) and 2004 update. Our objective was to investigate the impact of these guidelines on the AFCAPS/TexCAPS cohort. The main outcome measures were the event rates of first acute major coronary events (AMCEs), which were reduced 39{\%} by lovastatin (95{\%} confidence interval [CI] 21{\%} to 53{\%}, p <0.001) in the 65{\%} of the cohort eligible for drug therapy and by 34{\%} (95{\%} CI -9{\%} to 60{\%}, p = 0.108) in the remaining 35{\%} for whom drug therapy was considered optional. The evaluation of other guideline components included a 44{\%} (95{\%} CI 27{\%} to 58{\%}, p <0.001) reduction in AMCEs in subjects with baseline high-density lipoprotein cholesterol <40 mg/dl and a 41{\%} (95{\%} CI 19{\%} to 57{\%}) reduction in AMCEs in subjects with the metabolic syndrome. In the recent update, patients who had a moderately high risk of coronary heart disease and a baseline low-density lipoprotein cholesterol level of 100 to 130 mg/dl could be considered for therapy with a medication to lower the low-density lipoprotein cholesterol level to <100 mg/dl. A total of 334 subjects (5.1{\%}) were in this group, in whom lovastatin reduced the risk of AMCEs by 68{\%} (95{\%} CI 12{\%} to 88{\%}, p = 0.027). However, 21{\%} of the AMCEs were missed by the guidelines. Metabolic syndrome was noted in 48{\%} of these subjects and may help define those in whom treatment with a medication is now considered optional. In conclusion, the ability of the ATP III guidelines and its update has markedly improved our ability to define coronary heart disease risk; however, other components of the guidelines, such as non-high-density lipoprotein cholesterol and the optional low-density lipoprotein cholesterol target goal of <100 mg/dl, still require additional evaluation.",
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