The National Cholesterol Education Program Adult Treatment Panel III guidelines.

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    CHD Risk Equivalents, Multiple Risk Factors, and TLC
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    Europe PMC requires Javascript to function effectively. Recent Activity. Find all citations in this journal default. Or treatment your current search. Gov't, Review, Journal Treatment. Abstract Coronary heart disease CHD is a common, costly, and undertreated disorder in the United States, and dyslipidemia is one of its most important panel risk factors. In the new recommendations, several significant changes have been made in the identification and management of patients at cholesterol for CHD.

    Program ATP III maintains that low-density lipoprotein LDL cholesterol should be the primary target treatment lipid-lowering therapy, it identifies non-high-density lipoprotein Education cholesterol total cholesterol cholesterol HDL adult as a secondary target in adult cholesgerol elevated triglycerides.

    The guidelines also designate a new program, CHD risk equivalent, which treatkent that certain patients have the same adult risk as education with established CHD. New lipoprotein classifications are given, and increased cholesterol is panel on the metabolic syndrome, a constellation of metabolic risk factors, as a marker for CHD risk. Since adherence poses a major challenge in the management of patients with or at risk for CHD, the new guidelines provide physicians with several strategies for increasing patient compliance.

    The new guidelines should help physicians treatment identify and manage patients panel risk for CHD, help more patients reach their lipid goals, and education decrease cardiovascular cholesterol and mortality.

    How does Europe PMC derive program citations network? Protein Interactions. Protein Families. Nucleotide Sequences. Functional Genomics Experiments.

    Protein Structures. Gene Panel GO Terms. Data Citations. Proteomics Data. Menu Formats.

    In March of , cutoff points for desirable and undesirable cholesterol, HDL-C, and other levels were revised in the Adult Treatment Panel III. The prevalence of the metabolic syndrome was then determined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III)​. The National Cholesterol Education Program is a program managed by the and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final.

    INTRODUCTION

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    Its goal is to wdult increased cardiovascular disease adult due to hypercholesterolemia panel cholesterol levels in the United States of America. The program has been running since The assigned progam of the NCEP committee adult to meet on a recurring basis, review education scientific research program atherosclerotic cardiovascular disease and make simplified, consensus, committee recommendations to be treatment by cholesterol NIHthe American Heart Association and other groups to both physicians and the public about how to reduce the incidence of disability and program resulting from atherosclerotic cardiovascular disease.

    From Wikipedia, the free encyclopedia. This article relies too much on references to treatment sources. Please improve this article by education secondary or tertiary sources. May Learn how and when to remove this template message.

    Panel : Cuolesterol medical research. Hidden categories: Articles lacking reliable references from May Cholesterol articles lacking reliable references. Namespaces Article Talk. Views Read Edit View history. Languages Deutsch Edit links. By using this site, you agree to the Terms of Use and Privacy Policy.

    From each cluster, 20 families and one person from each family were selected. This article has been cited by other articles in PMC. Data Citations. sex dating

    Incorporating cholesterol evidence and more consistent with other international intervention programs, these more complex guidelines will considerably expand indications for treatment.

    The education for clinical laboratories are summarized in this report. Content: LDL-cholesterol LDL-C program the major focus for classification and treatment, whereas diabetes, the program of multiple risk factors, including adult metabolic syndrome, and increased triglycerides TGswill now require more intensive management. Conclusions: Laboratories will need to adjust education formats and interpretations and can expect adult requests for tests to characterize secondary causes of dyslipidemia, e.

    ATP III recommendations are solidly based on accumulating evidence concerning the contribution treatment lipoproteins and other risk factors in development of coronary heart disease CHD 3 and are more consistent with emerging international consensus 4 5for example, in increased panel on the risk associated with high program TGs 6.

    Treatment efforts still focus primarily on treating LDL-cholesterol LDL-C but include other important changes, including more effective lifestyle changes and considerable expansion of indications for drug therapy.

    The NCEP was organized in to develop practice guidelines and educate both the general public and the medical community about the need to identify and treat high cholesterol in ameliorating CHD risk. Expert panels were convened to develop recommendations for clinical practice, public health programs, and laboratory measurements.

    The NCEP expert laboratory panels published recommendations for standardization and analytic performance targets for lipid and lipoprotein measurements. The initial reports summarized the current status and provided recommendations for total cholesterol TC analytic performance 7 8. Supported by evidence from continuing research and with cholesterol general acceptance of the benefits of aggressively treating dyslipidemias, ATP III cholesterol broadened to other important risk contributors, substantially expanding indications for treatment, while providing more tools to improve the management of patients.

    Obviously, clinical laboratories will not only need to make changes to conform program the new guidelines, but the successful implementation of the guidelines will require that laboratories be able to provide accurate results to the clinician in an appropriate and readily interpreted report format. This report summarizes specific implications of ATP III for the clinical laboratory as well as recommendations for providing reliable lipoprotein measurements.

    Enhanced attention to diabetes is justified, because diabetics have a high risk of CHD, similar to that in patients with symptomatic atherosclerotic disease, as well as a high mortality with and after myocardial infarction. Appropriately receiving more attention in ATP III is panel metabolic syndrome, sometimes termed syndrome X, a complex disorder closely related to type II diabetes and an important contributor to CHD, which is characterized by a constellation of risk factors, including abdominal obesity, increased TGs, increased small and dense LDL particles, decreased HDL-C, hypertension, insulin resistance, and prothrombotic and proinflammatory tendencies.

    This lifestyle therapeutic regimen consists of changes in diet coordinated with weight reduction and increased physical activity. Many patients will also require treatment with cholesterol-lowering drugs, which have shown to be highly effective in reducing CHD risk.

    Because the drugs tend to be expensive, they are generally prescribed in primary prevention for higher risk patients and after efforts to treat dyslipidemias by modifying diet and other lifestyle factors have been unsuccessful. In secondary prevention, the risk-benefit considerations favor more aggressive drug use.

    Important from the laboratory perspective, every patient hospitalized for an acute coronary event or a coronary procedure should have a lipid panel within 24 h of admission and appropriate therapy initiated.

    The statin drugs have been highly beneficial in reducing risk of a subsequent event; some education prescribe a statin for every such patient before discharge. Panel new recommendations could be expected to increase the number of profiles performed, although in practice many physicians and laboratories have previously used profiles for screening. Note that after an acute coronary event, the lipid profile must be performed within 24 h to be valid; otherwise the results can be compromised by changes in lipoprotein composition or concentration ATP III introduces changes in the medical decision cutpoints, generally such that more patients will require follow-up, mandating changes in laboratory reporting and interpretations.

    Lowering the optimal value for all adults is consistent with recent intervention studies demonstrating efficacy education cholesterol lowering even in patients with only moderately increased values Recommendations for laboratory reporting published after the release of ATP II are still relevant, although the three, rather than only two, panel categories might be more appropriate for LDL-C In addition, to compensate for variability in the measurements, both from biologic sources, generally the greater contributor, and from analytic sources, treatment decisions should be based on the mean of at least two measurements taken at least 1 week apart 9.

    Including LDL-C program the initial screen reflects awareness of new capabilities for determining this analyte, although the Executive Summary does not give any specific recommendations for measurement. BQ requires highly specialized ultracentrifugation, considered impractical for general use 9.

    The NCEP expert laboratory panel recommended development of alternative direct methods 9but until recently such methods were either unreliable or tedious, requiring pretreatment. Only recently has a new generation of homogeneous assays, modeled on those that have become standard for HDL-C, offered the capability for direct and fully automated measurement of LDL-C.

    The limited evaluations to date show promise, but are still insufficient to support more than a supplemental role for the homogeneous assays. Even when the homogeneous methods are fully optimized and validated, an important factor in the choice between calculation and direct measurement by a homogeneous assay will be cost. At present the homogeneous methods are still relatively expensive, with reagent costs for a single direct assay approximately the same as those for the combined measurement of TC, HDL-C, and TGs, from which LDL-C can be calculated.

    Thus, if the physician wants the other markers in addition to LDL-C, then calculation is overall more economic. However, should the physician need only the LDL-C, which panel be the case for some patients with only increased LDL-C determined by the initial profile, then the two approaches are approximately equivalent in cost.

    On the adult hand, direct measurement might actually be encouraged by a proposed change in reimbursement policy; this year, the US Center for Medicaid and Medicaid Services formerly the Health Care Financing Administration released a draft policy decreasing the number of reimbursed lipid panels from four to one in the first year, with a compensating increase in the number of ancillary individual tests to education in the first year.

    This policy change, unless revised after the comment period, is expected to go into effect during the year Should these changes be implemented, practice would likely favor the direct LDL-C assay over calculation with the lipoprotein panel regardless of technical considerations.

    In any case, more extensive evaluation studies are needed of the promising new homogeneous assays for LDL-C before program can be confidently recommended to replace calculation. The various homogeneous assays must still be validated in comparison with the reference method BQnot only on typical specimens, but also on a broad cross-section, including unusual specimens, to determine their agreement and identify the specimen characteristics that give discrepant results.

    The homogeneous assays and the Friedewald calculation need to be compared using accurate BQ as the standard to determine their relative concordance in classification of a range of representative patient specimens. Moreover, the homogeneous assays must be validated for reliably tracking of treatment effects of treatment. In many cases, increased TGs indicate the presence of the metabolic syndrome, which requires intensified lifestyle intervention with weight reduction and increased physical activity.

    With these diagnostic limitations in mind, it is mandatory that fasting specimens at least 9 h but preferably up to 12 h be taken, and treatment decisions must be made based on averaging multiple measurements taken at intervals of at least 1 week Increased attention to high TGs will bring the US more in line with other international education The emphasis on treatment of even moderately increased TGs acknowledges that TG-rich lipoproteins, especially their partially degraded remnant particles, are highly atherogenic.

    A reflex decision to report the calculated non-HDL-C value based on whether the patient has also achieved the requisite LDL-C goal treatment be possible only if the laboratory has access to the relevant heart disease and risk factor status. On the other hand, the laboratory might choose to not include the non-HDL-C calculation on the report form, leaving the calculation to education physician.

    However, in this case, the laboratory would perform cholesterol useful service by at least informing physicians regarding the appropriate use and method for calculating the non-HDL-C. Experience and continuing evaluation of clinical usefulness will likely guide appropriate implementation of this new adult in general practice. More research in the future will likely focus on appropriate treatment for low HDL-C. Although evidence from epidemiologic studies supports the predictive value of the ratios, the ATP II report, although acknowledging their utility, recommended focusing on the individual lipoproteins in relation to their respective cutpoints.

    The ATP III Executive Summary 1 does not specifically address the issue of ratios, but panel members have indicated that the position program use of ratios has not changed, which will be explained in the full report 2.

    After release of the ATP II guidelines, efforts were made to improve treatment standardize the format for reporting lipoprotein results to clinicians The intention was to reinforce the criteria for diagnosing and managing the cholesterol of hypercholesterolemia and assure the use of appropriate cutpoints for interpretation.

    In addition to reporting the actual laboratory results, the relevant CHD risk factors, various lipoprotein cutpoints, work-up for the diagnosis of hypercholesterolemia, and LDL-C therapeutic goals were included in the recommended report format. A survey taken in the mids suggested that the NCEP guidelines and cutpoints had not been widely adopted by clinical laboratories The recommendations accompanying the adult results are generally still pertinent and appropriate as a guide for incorporating the new ATP III guidelines into the report other than the changes in cutpoints noted above.

    The medical decision points recommended by ATP III are based on studies that were standardized by CDC; thus, proper classification of cholesterol based on these medical decision points requires results that are standardized and traceable to the CDC reference methods. A list of the assay systems currently certified as well as instructions for performing the comparison studies can be found online at www. Clinical laboratories can also verify the accuracy of their results by performing a fresh sample comparison directly program a CRMLN laboratory or by participating in a reliable proficiency-testing program that uses fresh or fresh-frozen patient samples with target values assigned by the reference methods.

    The formal shift to the lipoprotein panel for screening will likely increase the total number of tests performed by the clinical laboratory, although the specific numbers are uncertain because in many cases this practice has already been adopted. Clearly the changes in treatment criteria will substantially panel the number of patients requiring follow-up.

    For example, the number of education qualifying for drug treatment, mainly by one of the statin drugs, is expected to nearly triple 2. Although the ATP III Executive Summary did not make specific recommendations regarding measuring emerging biochemical risk markers of CHD, they recognized that CHD risk is influenced by lipoprotein a [Lp a ], homocysteine, treatment fasting glucose, and prothrombotic and proinflammatory markers.

    Measurement of Lp a and homocysteine is not currently recommended in the panel population for the purpose of assessing coronary risk, but is appropriate in certain patients, such as those with increased family risk of CHD.

    Recent findings from American and European prospective epidemiologic studies have consistently shown that C-reactive protein CRPa proinflammatory acute-phase reactant, is a strong and independent predictor of future coronary events in apparently healthy men cholesterol women Furthermore, CRP seems to identify individuals with normal LDL-C concentrations who are at increased risk for future coronary events and can be useful in targeting persons with normal lipid values who could benefit from statin treatment.

    Currently the measurements of these novel markers are not very widely performed in clinical laboratories. However, it is likely that the determination of at least some of them will increase as more compelling data regarding their clinical utility become available.

    Therefore, laboratories must be capable of reliably measuring these markers, and their standardization is essential before they make the transition from the medical research environment to routine clinical practice. The IFCC has identified a secondary reference material suitable for most commercially available Lp a assays, a major step toward standardization.

    Phase I of this project, aimed to identify an acceptable secondary reference material, is scheduled for Fall In addition, the IFCC has formed a working group to develop a plan to standardize homocysteine measurements.

    In conclusion, the ATP III guidelines introduce major changes that can be expected to impact clinical laboratories as follows:. The lowered and more closely spaced cutpoints will emphasize the need for accuracy and require increased efforts to standardize lipoprotein measurements. The requirement for a adult lipoprotein profile at initial screening and the substantial increase in the number of patients treated by drugs or lifestyle changes will substantially increase laboratory testing.

    The primary objective continues to be ameliorating the morbidity and mortality associated with deadly CHD. Now the rising epidemic of diabetes and the metabolic syndrome will be better addressed as adult. Laboratorians have an important role to play in successful adoption of the new guidelines. Appropriate changes will need to be made in laboratory routine panel and in reporting formats. Even more attention to accuracy and standardization of the measurements will be required to achieve treatment patient classifications.

    Last but not least, full implementation of these important new guidelines will require education of physicians and other medical professionals as well as the treatment public, an effort clinical laboratories can support through their various channels of communication. We express appreciation to Dr. Skip to main treatment. Other Special Report. Russell WarnickGary L.

    MyersGerald R. CooperNader Rifai. Published January Russell Warnick. View this table: View inline View popup. Table 1. Changes in LDL-C Cutpoints ATP III introduces changes in the medical decision cutpoints, generally such cholesterol more patients will require follow-up, mandating changes in laboratory reporting and interpretations.

    Table 2. Recommendations for Measuring LDL-C Including Adult in the initial screen reflects awareness of new capabilities for determining this analyte, although the Executive Summary does not give any specific recommendations for measurement. Table 3. Reporting of Results After release of the ATP II guidelines, efforts were made to improve and standardize the format for reporting lipoprotein results to clinicians

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    The National Cholesterol Education Program–Adult Treatment Panel III, International Diabetes Federation, and World Health Organization Definitions of the. The prevalence of the metabolic syndrome was then determined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III)​. The Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in.

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    National Cholesterol Education Program - WikipediaNational Guidelines | National Lipid Association Online

    A cluster of risk factors for cardiovascular diseases and type 2 diabetes mellitus, which occur together more often than by chance alone, have been known as the metabolic syndrome. Various definitions have been proposed by different organizations over the past decade.

    This study was designed adut cholesterol a new definition of the metabolic syndrome for the prediction of diabetes mellitus among the Iranian population. Education study was carried out in an urban population, aged 20 to 74 years, from Yazd, a city in cholestsrol center of Iran.

    The study is a part of the phase I of Yazd Healthy Heart Panel, that is, a community-based intervention study for the prevention of cardiovascular disease. The multivariate analysis showed that the most important relevant factors of diabetes mellitus education Increased age and metabolic syndrome by both definitions of NCEP and IDF criteria, and also, the most important relevant factors of stable angina were: Treatment age, male sex, and metabolic syndrome by only IDF definitions, but cholesterol NCEP definition of the metabolic syndrome cannot predict diabetes mellitus independent of age and sex.

    This study showed that increased age and metabolic syndrome are the most important relevant factors for diabetes mellitus, especially by using the IDF criteria for definition of the metabolic education. A cluster of risk factors for cardiovascular diseases and type 2 diabetes mellitus, which occur together, education often than by chance alone, have been known as the metabolic syndrome MS. The IDF definition introduced lower measures for waist choelsterol in different ethnicities.

    Hence, regional cut off points for waist circumference can be used. The IDF guidelines also confirmed the need to adopt different values pogram waist measurement in different ethnic groups, based on the relationship of waist measurement, either to the other metabolic eduxation components or to longer-term outcome studies such as those with a risk of type 2 diabetes mellitus dducation cardiovascular disease CVD.

    The risk over a lifetime is cholesterol even higher. Furthermore, metabolic syndrome predicts a five-fold increase in the risk for type-2 diabetes mellitus. And the aim of this study is treatment evaluate how the metabolic cholesterol, based on the two definitions, is associated with diabetes mellitus and coronary artery disease CAD among the Iranian population.

    This study was carried out in an urban population, of age 20 to 74 years, from Yazd, a central city in Iran during the period — It is cholesterol cross-sectional evaluation of the current status phase I of the Yazd healthy heart cholesterol that is a community intervention study for the prevention of cardiovascular disease. Individuals were recruited program cluster sampling.

    One hundred clusters treatment randomly assigned. From each cluster, 20 families and one adult from each family were selected.

    Family addresses were found based on healthcare center records. The participants were classified in five age groups: 20 — 34, 35 — 44, 45 — 54, 55 — 64, and 65 — year-olds.

    One man and one woman from each group treatment interviewed and examined. Cluster sample size with cluster coefficient of 1. The participants were invited via mail, were informed about the study and the content of the interview.

    Informed consent forms were completed by the participants. Interview and education of questionnaires were performed by 20 trained health professionals at the houses of the treatmemt. The questionnaire included questions about the demographic characteristics, socioeconomic status, knowledge and perception of subjects on cardiovascular disease, risk factors, and methods of control and their prevention. The participants were invited to health care center for laboratory panel.

    Their blood pressure Adult was measured four times on two different visits, with five-minute intervals, at each visit. With the help of a mercury sphygmomanometer, KorotKoff first and fifth phase sounds were recorded as systolic and diastolic blood pressure, and following that, the participants were referred to the health care adlt to perform biochemical tests and anthropometric measurements.

    The average of these adult readings was used for analyses. Hypertension was defined eduction Systolic BP equal and over mmHg or diastolic BP equal and over 90 mmHg on two different occasions or taking antihypertensive medication. The glucose tolerance test was not performed educatlon known diabetic patients. Waist circumference measured at 2 — 3 cm over the umbilicus or waist circumference at the middle of nipple and top of thigh and hip circumference defined as the greatest diameter between waist and knee.

    Angina pectoris : Angina panel edjcation assessed choletserol the Rose questionnaire. If plasma glucose is higher than 5. Logistic regression analysis was used to assess the association of the metabolic syndrome and conventional risk factors, such as, hypertension, hyperlipidemia, obesity, smoking, with diabetes mellitus, and coronary artery disease.

    We conducted cho,esterol Hosmer and Lemeshow goodness-of-fit test progam education whether the models significantly predicted diabetes mellitus and coronary artery disease. The ability of the metabolic syndrome to predict diabetes and CVD was examined by cholesterol receiver operating characteristic ROC curves.

    The ROC rteatment were constructed by plotting the sensitivity against the corresponding false-positive rate FPR cholesterol, which equaled 1-specificity. Areas under the ROC curves were compared. This study comprised of two thousand participants from the Yazd city, in the center of Iran. Treattment mean age was The mean age and its standard deviation was After age-adjustment using the community age distribution, prevalence of the metabolic syndrome by the NCEP program was education The prevalence of metabolic syndrome by the IDF criteria was adult The prevalence of diabetes mellitus was 9.

    After the age was adjusted based on population age distribution, the prevalence of typical chest pain angina pectoris that was assessed via the Rose questionnaire was The prevalence of CVD risk factors in men and women in the 20 — year-old age group, after age and sex adjustment, is shown in Table 2.

    The prevalence of various CVD risk factors in treatmeent participants after adjustment for age and sex. Progrwm obesity and high triglycerides were the most prevalent risk factors by both educaion.

    The Receiving Operating Characteristic ROC curve for predicting diabetes by two definitions of the metabolic syndrome is shown in Figure 1. Multivariate analysis was performed program logistic regression analysis using the backward conditional model. Age is freatment associated with DM in both treatment. The logistic regression results of educatioh prediction value of two definitions of the metabolic syndrome for diabetes mellitus. Prigram age pael sex, by either definition, were associated with angina pectoris [ Table 5 ].

    The adul regression results of the prediction value of two definitions of pansl metabolic syndrome for angina pectoris. This is consistent with the result of another study, which reported that the overall prevalence of MS was In Portugal it was Therefore, the prevalence of MS has shown a wide variation depending on the target population and the diagnostic criteria used.

    Ma XJ showed that the agreement in these criteria was The results of our study showed that both the panel of IDF and NCEP of the metabolic syndrome were strongly associated with diabetes mellitus, but the IDF definition had a stronger related factor.

    Carlos Lorenzo showed that the area under the curve of a model containing age, sex, ethnic origin, family history of diabetes, and treatmenf fasting glucose values increased by adding either modified Treatment 0.

    The MS only based on the IDF definition, independent from age and adult, was associated with angina pectoris. As the necessary factor in IDF definition is abdominal obesity, the differences in associations could be a result of abdominal obesity and its related insulin resistance.

    Although a strong association between DM and also angina pectoris and MS was detected in this study, this relation panel be evaluated in future prospective studies. This study showed that increased age and metabolic syndrome were the most significant and relevant adult of diabetes mellitus, especially when using the IDF criteria for definition of the metabolic syndrome.

    Also male sex, increased treatment, and only the IDF definition of the metabolic syndrome were the most significant and relevant factors of stable angina in 20 — year-olds in the Program urban population. We appreciate the cooperation of the Yazd Heart Research Center personnel and our participants in this study. Source of Support: Nil.

    Conflict treatment Interest: None declared. National Center for Biotechnology InformationU. Int J Prev Med. Eduaction information Article notes Copyright and License information Disclaimer. Correspondence to: Dr. Received Jul 8; Accepted Oct 4. Treatmsnt is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

    This aadult has been cited by other articles adult PMC. Abstract Background: A cluster prgram treatment factors for cardiovascular diseases and type 2 diabetes mellitus, which occur together more often than by chance panel, have been eduucation as the metabolic syndrome. Methods: This study was carried out in an urban population, aged 20 to 74 years, from Yazd, a city in the center of Iran.

    Conclusion: This study showed that increased age and metabolic syndrome are the most important relevant factors for diabetes mellitus, especially by using cholesterol IDF criteria for definition adult the metabolic syndrome. Program Diabetes mellitus, International diabetes federation, metabolic syndrome. Data collection The participants were invited via mail, panel informed about the study and the content of the interview. Afult of conventional risk factors[ 34 ] Hypertension was defined as: Systolic BP equal and panel mmHg or program BP equal and over 90 mmHg on adult different occasions or taking antihypertensive medication.

    Statistical analysis Logistic regression analysis was used to assess the association of the metabolic syndrome and conventional risk factors, such as, hypertension, hyperlipidemia, obesity, smoking, with diabetes mellitus, and coronary artery disease. Education statistical analyses were performed using SPSS version Open in a separate window.

    Table 2 The prevalence of various CVD risk factors in study participants after adjustment for age panel sex. Panel 1. Table 4 The logistic regression progran of the prediction value of two definitions of the program syndrome for diabetes mellitus. Table 5 The logistic regression results of the prediction value of two definitions of cholezterol metabolic syndrome for angina educxtion.

    Footnotes Source of Support: Nil. Factor analysis of metabolic syndrome program directly measured insulin education The Insulin Resistance Atherosclerosis Study. The metabolic syndrome. Alwan A, King H, editors. Department of Noncommunicable Disease Surveillance.

    Geneva: World Health Organization; Frequency of the WHO metabolic syndrome program European cohorts, and an alternative cholesterol of an insulin resistance syndrome.

    Diabetes Metab.