Page 66 - Encyclopedia of Nursing Research

CARDIovASCULAR RISK FACToRS: CHoLESTERoL n 33

emphasized throughout ATP III: the intensity adherence over time to the prescribed die-
of risk-reduction therapy should be adjusted tary regimen. The first priority of pharmaco-
to an individual’s absolute risk. logical therapy is to achieve the appropriate C
The Framingham projections of 10-year LDL-C goal (as defined by the individual’s
absolute CHD risk (i.e., the percent proba- category of risk). ATP III recommends the use
bility of having a CHD event in 10 years) are of HMG-CoA reductase inhibitors (statins) as
used to identify and risk stratify individu- first-line therapeutic agents. In a meta-anal-
als. In addition to LDL-C, risk determinants ysis of clinical trials, the average reduction
include presence or absence of CHD and in TC in more than 30,000 middle-aged men
other clinical forms of atherosclerotic dis- followed for more than 5 years was 20%, the
ease, cigarette smoking, hypertension (blood average reduction in LDL-C was 28%, and the
pressure ≥ 140/90 mm Hg or on antihyperten- decline in triglyceride averaged 13% (LaRosa,
sive medication), low high-density lipopro- He, & vupputuri, 1999). Results of a landmark
tein cholesterol (<40 mg/dl), family history secondary prevention trial suggested that
of premature CHD, and age (men ≥ 45 years, early and continued lowering of LDL-C with
women ≥ 55 years). The category of highest an intensive lipid-lowering (statin) regimen
risk (10-year risk > 20%) includes CHD and provides greater protection against death or
CHD risk equivalents (other clinical forms major cardiovascular events than a standard
of atherosclerotic disease, diabetes) and has regimen (Cannon et al., 2004). other pharma-
a goal of LDL-C defined as less than 100 mg/ cological agents currently used in treatment
dl. The intermediate risk category (10-year of dyslipidemia in adults include bile–acid
risk ≤ 20%) includes multiple (2+) risk factors binding resins, niacin, and fibrates. The
and has a goal LDL-C as 130 mg/dl; the low- decisions to initiate LDL-C-lowering drug
est risk category (10-year risk < 10%) includes therapy, the type and dosage of agent to be
0 and 1 risk factors with an LCL-C goal of used, and the schedule for monitoring indi-
160 mg/dl. vidual response to therapy are based on the
The cornerstone of treatment for hyper- individual’s baseline risk status. normally,
cholesterolemia and other lipid abnormalities the patient’s response is evaluated approxi-
is TLC, with emphasis on dietary modifi- mately 6 weeks after starting drug therapy.
cation, increased physical activity, and nor- Relatedly, TLC continues throughout (and
malization of body weight. The important beyond) the duration of pharmacotherapy.
components of the TLC diet are saturated fat Consistent with recommendations of
(<7% of total calories), polyunsaturated fat the 33rd Bethesda Conference on preventive
(up to 10% of total calories), and monounsat- cardiology (ockene, Hayman, Pasternak,
urated fat (up to 20% of total calories). Less Schron, & Dunbar-Jacob, 2002), ATP III iden-
than 200 mg/day of dietary cholesterol, 50% tifies and targets adherence-enhancing inter-
to 60% of total calories from carbohydrates, ventions that consider the characteristics of
and approximately 15% of total calories the individual patient, the provider, and the
from protein are recommended. other key systems of health care delivery. Case man-
components of the TLC diet include viscous agement by nurses within the context of mul-
fiber, plant stanols/sterols, and soy protein. tidisciplinary team approaches is considered
Considerable variation in response to dietary an integral component of increasing adher-
modification has been observed in males and ence to therapeutic regimens for hypercho-
females across the life span. variations in lesterolemia and other lipid abnormalities.
serum TC, for example (ranging from 3% to The nCEP has not revised the 1991
14%), are attributed to individual differences definitions and guidelines for management
in biological mechanisms, baseline TC levels, of hypercholesterolemia in children and
nutrient composition of baseline diets, and adolescents in the United States; however,