| The relative influence of secondary versus primary prevention using the National Cholesterol Education Program Adult Treatment Panel II guidelines. | |
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MedLine Citation:
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PMID: 10483959 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study was undertaken to project the population-wide effect of full implementation of the Adult Treatment Panel (ATP) II guidelines of the National Cholesterol Education Program (NCEP). BACKGROUND: The ATP II has proposed guidelines for cholesterol reduction, but the long-term epidemiologic influence of its components has not been fully examined. METHODS: We used a calibrated, validated simulation of the U.S. population, aged 35 to 84 years to estimate the potential for the NCEP guidelines, under varying assumptions, to reduce coronary heart disease morbidity and mortality and overall mortality from the years 2000 to 2020. RESULTS: Primary prevention would yield only about half of the benefits of secondary prevention despite requiring nearly twice as many person-years of treatment. The projected increase in quality-adjusted years of life per year of treatment for secondary prevention was 3- to 12-fold higher than for primary prevention. To yield population-wide epidemiologic benefits equivalent to NCEP recommendations for secondary prevention, primary prevention would require a nearly sixfold increase in the number of persons treated compared with NCEP recommendations. All benefits of universal success of the NCEP primary prevention "screen and treat" guidelines could be achieved by a 11 mg/dl (8%) population-wide reduction in low-density lipoprotein cholesterol levels among persons without preexisting coronary heart disease. CONCLUSIONS: The NCEP guidelines for targeted primary prevention can be a useful component of a rational public health strategy, but only as a complement to the more appealing strategies of secondary prevention and "across-the-board" programs to lower all cholesterol levels. |
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Authors:
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L Goldman; P Coxson; M G Hunink; P A Goldman; A N Tosteson; M Mittleman; L Williams; M C Weinstein |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 34 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1999 Sep |
Date Detail:
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Created Date: 1999-09-24 Completed Date: 1999-09-24 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 768-76 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, University of California, San Francisco, School of Medicine, 94143-0120, USA. goldman@medicine.ucsf.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Age Factors Aged Aged, 80 and over Cholesterol / blood* Coronary Disease / blood, diet therapy, prevention & control Female Health Education* Humans Hypercholesterolemia / blood, diet therapy, prevention & control* Male Middle Aged Practice Guidelines as Topic Primary Prevention* / methods Quality-Adjusted Life Years Risk Factors United States |
| Grant Support | |
ID/Acronym/Agency:
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R01 H5-06258//PHS HHS |
| Chemical | |
Reg. No./Substance:
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57-88-5/Cholesterol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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