What is the National Cholesterol Education Program (NCEP)?

Answer

The goal of the National Cholesterol Education Program (NCEP) created in 1985 by the National Heart, Lung, and Blood Institute (NHLBI) is to educate both the public and medical professionals about the benefits of lowering cholesterol levels so as to reduce the risk for coronary heart disease. Pediatric guidelines for cholesterol screening are based on a consensus report that is updated periodically.^{[15, 16, 17, 18]}

Abnormalities in lipid levels were initially defined as concentrations at or above the 95th percentile for TC, TGs, and LDL-C for age and sex, whereas low HDL-C concentrations were defined as lower than the 5th percentile for age and sex (see Table 3 below). Many of these cutoffs have been modified by the NCEP to define healthy or desirable levels and not merely levels outside of a certain concentration range defined statistically.

The NCEP has not defined desirable and undesirable TG levels for children and adolescents. For adults, the NCEP has defined desirable TG levels as less than 150 mg/dL, mildly elevated levels as 150-199 mg/dL, elevated levels as 200-499 mg/dL, and levels of 500 mg/dL or higher as very high.

At the University of Florida, hypertriglyceridemia in children is defined as TG levels at or above 125 mg/dL. This value of 125 mg/dL is easy to remember and approximates the mean 95th percentile for TGs in boys and girls across childhood and adolescence. Functionally mild hypertriglyceridemia in children is defined in this clinic as TG levels of 125-299 mg/dL, modest hypertriglyceridemia as TG levels of 300-499 mg/dL, marked hypertriglyceridemia as TG levels of 500-999 mg/dL, and massive hypertriglyceridemia as TG levels of 1000 mg/dL or higher. These cutoffs can be used when determining treatment approaches to hypertriglyceridemia. Desirable and undesirable fasting lipid levels in children and adults are listed in Table 3, below.

Table 3. NCEP Lipid Assessments for Children and Adults (Open Table in a new window)

Children (< 20 y)	Desirable level (mg/dL)	Borderline level (mg/dL)	Undesirable level (mg/dL)
TC	< 170	170-199	≥200
LDL-C	< 110	110-129	≥130
HDL-C^*	>45	35-45	< 35
TG^†	< 125	...	≥125
Adults (≥20 y)^‡	Desirable level (mg/dL)	Borderline level (mg/dL)	Undesirable level (mg/dL)
TC	< 200	200-239	≥240
LDL-C^§	< 130	130-159	≥160
HDL-C^\|\|	≥40	...	< 40
TGs	< 150	150-199	≥200
^* This was not established by NCEP; these values were the adult cutpoints used at the time that the pediatric NCEP guidelines were established. ^† This was not established by NCEP; a TG level of 125 mg/dL approximates the mean 95th percentile for TGs in boys and girls during childhood and adolescence. ^‡ In March of 2001, cutoff points for desirable and undesirable cholesterol, HDL-C, and other levels were revised in the Adult Treatment Panel III (ATPIII).^[18] ^§ The optimal LDL-C concentration is less than 100 mg/dL; in patients with cardiovascular disease or diabetes, the optimal LDL-C level is less than 70 mg/dL. ^\|\| If the HDL-C level is 60 mg/dL or higher, one risk factor for coronary heart disease can be subtracted in adults.

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Author

Henry J Rohrs, III, MD Assistant Professor, Department of Pediatrics, Division of Pediatric Endocrinology, University of Florida College of Medicine

Henry J Rohrs, III, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Desmond Schatz, MBBCh, MD Professor, Medical Director of Diabetes Center, Department of Pediatrics, Division of Endocrinology, University of Florida College of Medicine

Desmond Schatz, MBBCh, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, Endocrine Society, Florida Medical Association, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Sanofi Aventis<br/>Received income in an amount equal to or greater than $250 from: Sanofi Aventis.

William E Winter, MD Professor, Departments of Pathology and Laboratory Medicine and Pediatrics, University of Florida College of Medicine

William E Winter, MD is a member of the following medical societies: American Diabetes Association, American Association for Clinical Chemistry

Disclosure: Nothing to disclose.

Vanessa Davis, MD Fellow, Department of Pediatrics, Division of Endocrinology, University of Florida

Vanessa Davis, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Diabetes Association, American Medical Association, Endocrine Society, Pediatric Endocrine Society, National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John W Moore, MD, MPH Professor of Clinical Pediatrics, Section of Pediatic Cardiology, Department of Pediatrics, University of California San Diego School of Medicine; Director of Cardiology, Rady Children's Hospital

John W Moore, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD Executive Director of The Heart Center, Interim Division Chief of Pediatric Cardiology, Lurie Childrens Hospital; Professor, Department of Pediatrics, Northwestern University, The Feinberg School of Medicine

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

Christopher Johnsrude, MD, MS Chief, Division of Pediatric Cardiology, University of Louisville School of Medicine; Director, Congenital Heart Center, Kosair Children's Hospital

Christopher Johnsrude, MD, MS is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology

Disclosure: Nothing to disclose.

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