Part of the U.S. National Institutes of Health, the National Cholesterol Education Program (NCEP) is designed to optimize prevention and enhance the management of heart disease. This involves a systematic approach based on an individual’s long-term or short-term risk of heart disease.

As with previous recommendations, reduction of low-density lipoprotein (LDL) cholesterol continues to be the primary strategy. However, the NCEP now defines desired LDL levels based on the risk for developing coronary artery disease or having a cardiac event, such as a heart attack.

For healthy people, the NCEP recommends an optimal LDL cholesterol level of 100 milligrams per deciliter (mg/dL). This guideline, however, is not sufficient for patients already at higher risk of having a heart attack. For higher-risk patients, goals for LDL levels are set according to each patient’s risk category. These “therapeutic goals” in milligrams per deciliter (mg/dL) are:

A “therapeutic goal” is the target that physicians hope to reach through therapies to lower their patients’ LDL. Such therapy usually includes lifestyle changes (e.g., diet and exercise) and the use of cholesterol-reducing medications. The two stages of therapeutic goals (primary and secondary) give physicians the option of a lower goal for some patients.

Risk categories are determined by the National Heart, Lung, and Blood Institute (NHLBI) and based on a person's likelihood of having a heart attack in the next 10 years. These risk factors include:

The NCEP also promotes a series of dietary and fitness guidelines known as Therapeutic Lifestyle Changes. These include:

• Reduce dietary intake of saturated fat (less than 7 percent of total calories) and cholesterol (less than 200 milligrams a day).
  
• Achieve and maintain a healthy weight.
  
• Increase physical activity to at least 30 minutes on most days.

In addition to Therapeutic Lifestyle Changes, a physician may recommend cholesterol-reducing drugs to lower LDLs to desirable levels.