Abstract:
Purpose: The National Cholesterol Education Program (NCEP) III guidelines have been
hailed as an improvement in their potential to identify individuals at risk for coronary
heart disease (CHD) complications. Compared with the NCEP II, the new guidelines will
increase the number of patients who qualify for medical management. However, the
etIectiveness of these guidelines to identify young adults at risk for a cardiac event is yet
to be studied. The purpose of this study was to investigate the utility of the new NCEP III
guidelines in a group of young adults. Methods: A retrospective review of clinical data from young adults (age::; 55 years for
men and::; 65 years for women) hospitalized for acute myocardial infarction over a twoyear
period was conducted. Patients with a history of CHD or CHD equivalent were
excluded. Using the NCEP III guidelines, we calculated a lO-year risk for coronary
events on all patients. Results: A total of200 patients met criteria for inclusion. The mean age was 49 years
and 31 % were women. Mean lipid levels were all within the normal range, however, rates
of smoking and obesity were high. When the 10-year risk of these patients was stratified
by the number of risk factors and low-density lipoprotein cholesterol level, only 20% met
criteria to qualify for pharmacotherapy. Conclusion: The new guidelines offer multiple new features but have a tendency to
under appreciate the risk for disease in young adults. To improve performance in young
adults, statistical adjustments may be necessary.
