We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Review |

An Evidence-Based Assessment of the NCEP Adult Treatment Panel II Guidelines

Benjamin J. Ansell, MD; Karol E. Watson, MD, PhD; Alan M. Fogelman, MD
JAMA. 1999;282(21):2051-2057. doi:10.1001/jama.282.21.2051.
Text Size: A A A
Published online

Context The Second Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) was issued without the benefit of multiple recently published large clinical trials.

Objective To analyze the panel's guidelines for treatment of high cholesterol levels in the context of currently available clinical trial results.

Data Sources MEDLINE was searched for all English-language clinical trial data from 1993 through February 1999 relating to the effects of cholesterol treatment on cardiovascular clinical outcomes.

Study Selection Studies that were selected for detailed review assessed the effects of cholesterol lowering on either coronary events, coronary mortality, stroke, and/or total mortality, preferably by randomized, double-blind, placebo-controlled design. Selection was by consensus of a general internist, a lipid clinic director, and a researcher in atherosclerotic plaque biology. A core of 37 of the 317 initially screened studies were selected and used as the primary means by which to assess the guidelines.

Data Extraction By consensus of the group, only prespecified end points of trials were included, unless post hoc analysis addressed issues not studied elsewhere.

Data Synthesis Recent clinical trial data mostly support the Adult Treatment Panel II guidelines for cholesterol management. While existing trials have validated the target low-density lipoprotein cholesterol (LDL-C) goals in the report, studies are lacking that address mortality benefit from reduction below these levels. Few lipid-lowering trials have treated patients with low high-density lipoprotein cholesterol and/or elevated triglyceride levels with LDL-C levels at or below treatment goals.

Conclusions Lipid-lowering therapy generally should be more aggressively applied to patients with diabetes and/or at the time of coronary heart disease (CHD) diagnosis. The evidence for statin use in secondary CHD prevention in postmenopausal women outweighs current evidence for use of estrogen replacement in this setting. Further studies are needed to address the effects of lipid modification in primary prevention of CHD in populations other than middle-aged men and to study markers of lipid metabolism other than LDL-C.

Figures in this Article


Figure. Adult Treatment Algorithm for Preference of Lipid-Lowering Therapy Based on Findings From Lipid Intervention Trials
Graphic Jump Location
LDL-C indicates low-density lipoprotein cholesterol; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol; CHD, coronary heart disease; asterisk, type 2 diabetes of any duration or type 1 diabetes of more than 10 years' duration; dagger, lipid-lowering medication is not recommended for women of childbearing age unless the patient has known CHD or diabetes or is at high risk as described herein; double dagger, combination is not approved by the US FDA; section mark, nonpharmacological therapy includes American Heart Association diet, achieving desirable weight, and regular excercise; parallel mark, other risk factors include male sex, postmenopausal female sex, smoking, hypertension, and family history of premature CHD. To convert LDL-C and HDL-C from milligrams per deciliter to millimoles per liter, multiply by 0.02586. To convert triglycerides from milligrams per deciliter to millimoles per liter, multiply by 0.01129.



Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

71 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles