Under the new Medicare guidelines, one Lipid Panel may be ordered each year.  For all interim visits, the health care provider must choose one analyte for monitoring (triglycerides, HDL or direct LDL).  The selected test will be covered six times in the first year.  From that point on, either total cholesterol or direct LDL may be measured up to three times per year.

The NCEP produced several guidelines regarding the use of LDL in its Adult Treatment Panel III (ATP III) publication.  The initial recommendation is that all adults over 20 years of age obtain a fasting Lipid Panel (total cholesterol, triglycerides, LDL and HDL) once every five years as a screening test.  If abnormalities are noted, LDL is the test recommended to be utilized for follow-up.  The LDL test results are then used in conjunction with other risk determinants to evaluate the patient status and to determine a clinical plan of action, if indicated.  ATP III classification of LDL results can be seen in Table 1.

The report defines three categories of risk and gives goals for LDL testing results (see Table 2).

The highest risk category consists of those patients with demonstrated CHD, those with other forms of atherosclerotic disease, diabetes and other multiple risk factors which demonstrate a ten year risk score for CHD of greater than 20 percent as estimated from Framingham Study risk scores (see Tables B1 and B2).  The LDL goal for these patients is less than 100 mg/dl.

The second risk category listed in Table 2 includes those patients with two or more risk factors as listed in Table 3 and demonstrate a Framingham Study risk score of equal to or less than 20 percent.  The LDL goal for this group of patients is less than 130 mg/dl.

The third risk category listed includes those patients with 0-1 risk factors.  The LDL goal for this group of patients is less than 160 mg/dl.

The ATP III report also addresses the use of LDL when dealing with patients exhibiting other specific dyslipemias, such as elevated serum triglycerides, very high LDL (greater than 190 mg/dl) levels, low HDL levels and diabetic dyslipidemia.  In all of these cases, LDL remains the primary target of therapy.

The complete Executive Summary of the NCEP ATP III is available from the Marketing Department of RML or may be found in JAMA, May 16, 2001, Vol. 285, No. 19.  This publication outlines treatment recommendations.

Table 1.  ATP III Classification of LDL

Table 2.  Three Categories of Risk That Modify LDL Cholesterol Goals

Table 3.  Major Risk Factors that Modify LDL Goals

REFERENCES:

Executive Summary of the Third Report of the National Cholesterol Education Report (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), JAMA, May 16, 2001, Vol. 285, No. 19.