National Cholesterol Education Program
PROGRAM DESCRIPTION
The National Heart, Lung, and Blood Institute (NHLBI)
of the National Institutes of Health (NIH) launched the National Cholesterol
Education Program (NCEP) in November 1985. The goal of the NCEP is to
contribute to reducing illness and death from coronary heart disease (CHD) in
the United States by reducing the percentage of Americans with high blood
cholesterol. Through educational efforts directed at health professionals and
the public, the NCEP aims to raise awareness and understanding about high blood
cholesterol as a risk factor for CHD and the benefits of lowering cholesterol
levels as a means of preventing CHD.
Evidence of Progress
The NCEP has made significant strides toward its goal
of reducing the prevalence of high blood cholesterol in the United States.
Evidence of this progress is clearly visible in the results of national
surveys. The latest Cholesterol Awareness Survey (CAS) of physicians and the
public shows that from 1983 to 1995, the percentage of the public who had ever
had their blood cholesterol checked rose from 35 to 75 percent. This means that
some 70 to 80 million Americans who in 1983 were unaware of their blood
cholesterol level have taken action to learn where they stand. In 1995,
physicians reported initiating diet and drug treatment at much lower
cholesterol levels than in 1983, levels close to NCEP recommendations. The CAS
also shows that core elements of the NCEP guidelines for blood cholesterol
detection and treatment have become established practice. The efforts of the
NCEP and Coordinating Committee member organizations have led to significant
improvements in professional and public attitudes, knowledge, and practices
regarding high blood cholesterol and heart disease. The Third National Health
and Nutrition Examination Survey (NHANES III) (1988-1994) demonstrates that the
public's intake of saturated fat and total fat has declined. NHANES III also
shows that blood cholesterol levels have dropped. Since 1978, average total
cholesterol levels among U.S. adults have fallen from 213 mg/dL to 203 mg/dL,
and the prevalence of cholesterol of 240 mg/dL or higher has declined from 26
percent to 19 percent. Moreover, CHD mortality has continued to decline. Taken
all together, the progress indicators demonstrate that cholesterol education
has had a significant impact.
The NCEP Science Base
From its inception, the NCEP has based its
recommendations and messages firmly on sound scientific evidence. In January
1984, the Lipid Research Clinics Coronary Primary Prevention Trial provided the
long-sought, definitive evidence that lowering high blood cholesterol reduces
the risk for CHD. These results and a large body of evidence from laboratory,
epidemiologic, and clinical studies showed that not only are high blood
cholesterol levels an important risk factor for CHD, but that these levels can
be lowered safely by both diet and drugs.
A series of recent clinical trials that used
cholesterol-lowering drugs called statins has provided conclusive
evidence that lowering the level of low density lipoprotein (LDL) cholesterol,
the "bad" cholesterol, dramatically reduces heart attacks and CHD deaths as
well as overall death rates in patients with or without existing CHD.
The NCEP Program Areas
The scientific evidence supports a continuation of
NCEP's two-pronged strategy for reducing blood cholesterol levels:
- The high-risk or clinical approach, which promotes
the detection and treatment of individuals whose elevated blood cholesterol
places them at significantly increased risk for CHD;
- The population approach, which seeks to lower
average levels of blood cholesterol by encouraging the gerneral public to adopt
reduced intakes of saturated fat and cholesterol, increased physical activity,
and weight control.
The NCEP Partnership
Since 1985, the NCEP has relied on partnerships to
promote implementation of its strategies and guidelines. The NCEP Coordinating
Committee, with its membership of more than 40 partner organizations, embodies
this partnership principle. Through the Coordinating Committee, the NCEP brings
cholesterol information to a wide audience. Consisting of representatives from
major medical and health professional associations, voluntary health
organizations, community programs, and governmental agencies, the Coordinating
Committee is the NCEP's policy-setting body and board of directors.
An important Coordinating Committee activity is
sponsorship of expert panels to develop guidelines for health professionals.
The NCEP distributes the panels' guidelines and recommendations to physicians
and other health care professionals and laboratories across the country. The
reports of these panels serve as the platform for a wide variety of NCEP
educational activities and materials. These panels include:
- Expert Panel on Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults (Adult Treatment
Panel)guidelines for detecting, evaluating, and treating high blood
cholesterol in adults.
- Laboratory Standardization Panel
guidelines for standardizing laboratory measurements and reporting of blood
cholesterol tests.
- Expert Panel on Population Strategies for Blood
Cholesterol Reduction (Population Panel) recommendations for reducing
blood cholesterol levels through populationwide adoption of eating patterns low
in saturated fat and cholesterol.
- Expert Panel on Blood Cholesterol Levels in
Children and Adolescentsrecommendations for heart-healthy eating
patterns for children and adolescents, and for detecting and treating high
blood cholesterol in children and adolescents from high-risk families.
- Working Group on Lipoprotein
Measurement recommendations to improve the measurement of
LDL-cholesterol, HDL-cholesterol, and triglyerides.
Member Organizations of the NCEP Coordinating
Committee
American Academy of Family Physicians American
Academy of Pediatrics American Association of Occupational Health
Nurses American College of Cardiology American College of Chest
Physicians American College of Nutrition American College of
Obstetricians and Gynecologists American College of Occupational
Medicine American College of Preventive Medicine American Diabetes
Association, Inc. American Dietetic Association American Heart
Association American Hospital Association American Medical
Association American Nurses Association American Osteopathic
Association American Pharmaceutical Association American Public Health
Association American Red Cross Association of Black Cardiologists
Association of Life Insurance Medical Directors of America Association of
State and Territorial Health Officials Citizens for Public Action on Blood
Pressure and Cholesterol, Inc. National Black Nurses Association, Inc.
National Heart, Lung, and Blood Institute National Medical Association
Society for Nutrition Education Society for Public Health Education
Associate Member Organizations of the NCEP
Coordinating Committee
American Association of Office Nurses
Federal Agencies
NHLBI Ad Hoc Committee on Minority Populations
Agency for Healthcare Research and Quality Centers for Disease Control and
Prevention Coordinating Committee for the Community Demonstration
Studies Department of Agriculture Department of Defense Food and
Drug Administration Health Resources and Services Administration
National Cancer Institute National Center for Health Statistics Office
of Disease Prevention and Health Promotion Department of Veterans
Affairs
The NCEP Goal and Objectives
The goal of the NCEP is to reduce the prevalence of
elevated blood cholesterol in the United States, and thereby contribute to
reducing CHD morbidity and mortality. To attain this goal, the NCEP has
established the following objectives for health professionals, patients and the
public, and the community.
Objectives for Health Professionals
- To increase awareness among health professionals
that elevated blood cholesterol is a cause of CHD, and that reducing elevated
blood cholesterol levels will contribute to the reduction of CHD risk.
- To improve the knowledge, attitudes, and skills of
health professionals to identify and intervene with patients who have elevated
blood cholesterol, and to provide guidelines regarding methods and approaches
to use in detection, treatment, and followup of patients.
- To encourage health professionals to consider an
individual's blood cholesterol level in relation to other CHD risk factors.
- To increase the awareness and understanding of
health professionals regarding the major role that diet plays in reducing
elevated blood cholesterol.
- To increase the awareness and understanding of
health professionals regarding the role of weight control and physical activity
in the management of high blood cholesterol.
- To increase the knowledge of health professionals
about the appropriate use of cholesterol-lowering drugs.
- To increase the proportion of health professionals
who diagnose and treat patients with high blood cholesterol in accordance with
the best existing information (e.g., measuring blood cholesterol levels at
appropriate intervals, initiating treatment at appropriate levels of blood
cholesterol, and providing adequate counseling support to patients).
- To promote interdisciplinary collaborative efforts
in the management of patients with elevated blood cholesterol. Proper
management of this condition requires close cooperation among health
professionals, including physicians, nurses, dietitians, and pharmacists.
- To improve the knowledge, attitudes, and skills of
students in the health professions regarding high blood cholesterol and its
management.
- To improve precision and accuracy in the
measurement of blood cholesterol levels and to promote standardized reporting
of laboratory results.
Objectives for Patients and the Public
- To increase awareness that elevated blood
cholesterol is a cause of CHD, and that reducing elevated blood cholesterol
levels will contribute to the reduction of CHD risk.
- To increase the proportion of Americans who have
reduced their dietary intake of saturated fat and cholesterol as part of a
nutritionally adequate diet.
- To increase the proportion of Americans who know
their blood cholesterol levels.
- To encourage people identified as having high blood
cholesterol to seek professional advice and followup.
- To increase awareness that diet plays a major role
in lowering high blood cholesterol, and that weight control and physcial
activity also play a role in the management of high blood cholesterol, and
that, if necessary, drugs may be added to the regimen.
- To increase public knowledge about the dietary
principles for reducing blood cholesterol levels.
- To increase the proportion of people with high
blood cholesterol who adhere to their cholesterol-lowering regimen.
Objectives for the Community
- To increase activities for blood cholesterol
control at the state and community level.
- To increase awareness and knowledge among students,
especially those in primary and secondary schools, with respect to blood
cholesterol and cardiovascular risk factors in general.
- To increase worksite activities to reduce elevated
blood cholesterol levels.
- To develop program activities and products that are
appropriate to the needs of minorities and other special populations and to
actively involve health professionals and organizations that serve these
populations.
- To promote increased dissemination of
scientifically accurate cholesterol-related information by print and electronic
media.
For more information on the NCEP, contact:
National Cholesterol Education Program NHLBI
Health Information Network P.O. Box 30105 Bethesda, Maryland
20824-0105 (301) 592-8573 phone (301) 592-8563 fax
http://www.nhlbi.nih.gov
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