Perspectives on cholesterol guidelines

Since the 1980s, cholesterol guidelines for Americans have been sponsored by The National Heart, Lung, and Blood Institute of the National Institutes of Health. These guidelines were produced by the National Cholesterol Education Program. From this program, an Adult Treatment Panel (ATP) has organized the major sets of guidelines. Three reports were issued by ATP. The third and last was updated by a smaller panel in 2004. More recently, the National Heart, Lung, and Blood Institute has turned the cholesterol guideline process over to the American College of Cardiology and the American Heart Association (ACC/AHA). Guidelines from other countries have generally followed the third ATP report. ACC/AHA guidelines have attempted to restrict their recommendations to information derived from randomized clinical trials. Thus, they are much narrower than ATP reports. The latter made recommendations on several lines of evidence, including clinical trials, epidemiology, genetics, and dietary and metabolic studies. Since the publication of ACC/AHA recommendations, considerable controversy has emerged on how best to develop cholesterol guidelines. This chapter examines this question and suggests potential approaches.