NCEP Guidelines for Cholesterol Management

The term "NCEP guidelines likely refers to updated guidelines for managing high cholesterol, such as the national Lipid Association’s Summary of the Adult Treatment Panel III (ATP III) recommendations or the National Institutes of Health (NIH) guidelines which are still widely referenced. The core principles involve risk assessment, starting with a fasting lipid profile for adults, and using the results to guide lifestyle changes and potential drug therapy, particularly statins. The latest updates, such as the European Society of Cardiology (ESC) guidelines from August 2025, also provide a framework for managing dyslipidaemias based on updated evidence. 

Key recommendations from the National Cholesterol Education Program (NCEP) and other sources are;

• Baseline screening: All adults 20 years and older should have a fasting lipoprotein profile (including total cholesterol, LDL, HDL, and triglycerides) at least every 5 years.

• Risk assessment: The intensity of therapy should be based on a person's absolute risk, which is determined by their LDL cholesterol level and other risk factors.

• Risk factors: Key risk factors for coronary heart disease (CHD) include being a male older than 45 or a female older than 55 (or premature menopause), a family history of premature CHD, current cigarette smoking, hypertension, low HDL-C (<40 mg/dL), and diabetes.

• Treatment for primary prevention (severe hypercholesterolemia): For patients with severe hypercholesterolemia (LDL-C > 190 mg/dL) and no concomitant atherosclerotic cardiovascular disease (ASCVD), high-intensity statin therapy should be initiated. A 10-year risk calculation is not necessary in this case.

• Treatment for primary prevention (diabetes): In patients with diabetes aged 40–75 with an LDL-C ≥ 70 mg/dL and no ASCVD, moderate-intensity statin therapy should be started. For older patients (≥50 years), a high-intensity statin or moderate-intensity statin plus ezetimibe can be considered to achieve a ≥ 50% reduction in LDL-C.

• Lifestyle changes: Lifestyle changes are the most cost-effective method to reduce risk. These include increasing physical activity and making dietary modifications.

• Management of triglycerides: If triglycerides are elevated (200–499 mg/dL) after the LDL goal is reached, the non-HDL goal should be pursued through weight management and increased physical activity. 

Other relevant updates 

• 2025 ESC Guidelines: The European Society of cardiology released a focused update in August 2025, which provides the latest recommendations for managing dyslipidaemias.

• Children and adolescents: Specific guidelines are in place for managing high cholesterol in children and adolescents, with a focus on lifestyle changes first. Drug treatment may be considered if lipid levels do not improve, and referral to a lipid specialist is recommended for severe cases.