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 Adolescents—recommendations 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