National Cholesterol Education Panel ΙΙΙ Guidelines Performance Role in Preventing Myocardial Infarction in a Large Cohort Without a History of Coronary Artery Disease: Korea Acute Myocardial Infarction Registry Study

Abstract

The Third Report of the Adult Treatment Panel National Cholesterol Education Program (NCEP-ATP III) guidelines are widely used for the primary prevention of a coronary event. These guidelines were developed using experimental data from studies that enrolled mostly Caucasian patients. The pathogenesis of atherosclerosis varies with ethnicity. Given these two circumstances, the authors sought to investigate the performance of the guidelines in a large Asian cohort. The Korea Acute Myocardial Infarction Registry (KAMIR) includes data collected between November 2005 and December 2006 from 41 referral centers in South Korea. A retrospective review of the clinical data was performed. After patients with a history of coronary heart disease (CHD), CHD equivalent, and those taking lipid-lowering medications were excluded, 2969 individuals (76% men; 61+/-12 years) were enrolled. The recommendations for lipid-lowering treatments according to the NCEP-ATP III were examined in the context of the cohort. A total of 38%, 66%, and 8% of the study participants had hypertension, were smokers, and had a family history of premature CHD, respectively. When patients were stratified by the number of risk factors present and their 10-year CHD risk, 69% diagnosed with an acute myocardial infarction did not qualify for drug therapy. Irrespective of the age group examined (young, intermediate, and old), the percentage of patients who did not qualify for a lipid-lowering pharmacologic intervention was higher than 60%. NCEP-ATP III underestimates CHD risk in individuals of Asian descent. Further studies are needed to improve primary CHD prevention in this patient population.

Application of New Guidelines for the Primary Prevention of Atherosclerotic Cardiovascular Disease in a Korean Population

“…In 2009 and 2012, two Korean studies revealed that the NECP-ATP III guidelines (the most popular Western guidelines for the primary and secondary prevention of cardiovascular disease) were not completely suitable for the Korean population 23,24) . Additionally, several Japanese studies have reported the clinical significance of statin therapy for the primary and secondary prevention of cardiovascular disease.…”

Current management of acute myocardial infarction: Experience from the Korea Acute Myocardial Infarction Registry

“…Thirty-day clinical outcome was worse in women than men both in STEMI and NSTEMI. In addition, Yoon et al [21] observed that the U.S. National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III recommendations [22], the most widely used guidelines for the primary prevention of coronary events, are less reliable in Koreans, particularly in women as compared with men.…”

Risk assessment and aspirin use in Asian and Western populations

“…Yoon et al48 found that application of the NCEP-ATP III guidelines, which were mainly developed from Caucasian patients, to data from the Korea Acute Myocardial Infarction Registry (KAMIR) resulted in undertreatment. Around 69% of patients with an acute MI did not qualify for drug therapy when they were stratified according to the risk factors present and the 10-year CHD risk.…”