Treat elevated triglycerides.
If triglycerides 200-499 mg/dL after LDL goal is reached, consider adding drug if needed to
reach non-HDL goal:
• intensify therapy with LDL-lowering drug, or
• add nicotinic acid or fibrate to further lower VLDL.
If triglycerides >
500 mg/dL, first lower triglycerides to prevent pancreatitis:
• very low-fat diet (<15% of calories from fat)
• weight management and physical activity
• fibrate or nicotinic acid
• when triglycerides <500 mg/dL, turn to LDL-lowering therapy.
Treatment of low HDL cholesterol (<40 mg/dL)
■ First reach LDL goal, then:
■ Intensify weight management and increase physical activity
■ If triglycerides 200-499 mg/dL, achieve non-HDL goal
■ If triglycerides <200 mg/dL (isolated low HDL) in CHD or CHD equivalent
consider nicotinic acid or fibrate.
9
Step 9
ATP III Classification of Serum Triglycerides (mg/dL)
<150 Normal
150-199 Borderline high
200-499 High
≥500 Very high
Treatment of elevated triglycerides (≥150 mg/dL)
■ Primary aim of therapy is to reach LDL goal
■ Intensify weight management
■ Increase physical activity
■ If triglycerides are >200 mg/dL after LDL goal is reached, set
secondary goal for non-HDL cholesterol (total – HDL)
30 mg/dL higher than LDL goal.
Comparison of LDL Cholesterol and Non-HDL Cholesterol Goals for Three Risk Categories
Risk Category LDL Goal (mg/dL) Non-HDL Goal (mg/dL)
CHD and CHD Risk Equivalent <100 <130
(10-year risk for CHD >20%)
Multiple (2+) Risk Factors and <130 <160
10-year risk <
20%
0-1 Risk Factor <160 <190