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Biohemijski Aspekti, Laboratorijska Dijagnoza I Praćenje Povišene Koncentracije Holesterola: Preporuke NCEP ATP III Treći izveštaj ekspertske grupe o detekciji, evaluaciji i tretmanu povišene koncentracije holesterola u odraslih (Adult Treatment Panel III, ATP III) predstavlja ažuriran klinički vodič Nacionalnog programa edukacije o holesterolu (National Cholesterol Education Program, NCEP), o određivanju holesterola i zbrinjavanju osoba s povišenom koncentracijom holesterola u serumu. Pored toga što preporučuje intenzivan tretman pacijenata sa koronarnom srčanom bolešću (coronary heart disease/CHD), važna karakteristika ATP III je težište na primarnoj prevenciji kod osoba sa više prisutnih faktora rizika. ATP III nastavlja da identifikuje povišene koncentracije LDL holesterola kao primarni cilj terapije za snižavanje holesterola. Osnovni princip prevencije je da se intenzitet terapije prilagođava apsolutnom riziku za CHD svake osobe pojedinačno. Procena rizika podrazumeva određivanje LDL holesterola u sklopu analize lipoproteina i identifikaciju pratećih determinanti rizika (prisustvo ili odsustvo CHD, drugih kliničkih oblika aterosklerotske bolesti i dijabetesa, pušenje, hipertenzija, niska koncentracija HDL holesterola, porodična anamneza prevremene pojave CHD, starost). U kategoriji najvišeg rizika nalaze se osobe sa CHD i CHD ekvivalentima rizika, čiji je apsolutni rizik od pojave srčane smrti ili nefatalnog infarkta miokarda u narednih 10 godina ≥20%. Drugu kategoriju čine osobe sa dva ili više faktora rizika kod kojih je 10-godišnji rizik <20%. Apsolutni rizik se procenjuje na osnovu Framingham rizik skora. U trećoj kategoriji su osobe sa jednim ili nijednim faktorom rizika. Definisane su preporučene koncentracije LDL holesterola za svaku kategoriju i postižu se korekcijom ishrane i/ili farmakoterapijom. Evropske preporuke za prevenciju kardiovaskularne bolesti (cardiovascular disease, CVD) u kliničkoj praksi preporučuju upotrebu SCO-RE (Systematic COronary Risk Evaluation) tablica za procenu rizika za pojavu CVD, koje podrazumevaju apsolutnu verovatnoću za fatalan ishod CVD u toku 10 godina. Cilj ovog rada je predstavljanje delova NCEP ATP III i evropskih preporuka značajnih za njihovu implementaciju u laboratorijsku praksu. Biochemical Aspects, Laboratory Diagnosis and Follow-Up of High Blood Cholesterol: NCEP ATP III Guidelines The Third Report of the expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III, ATP III) constitutes the National Cholesterol Education Program's (NCEP's) updated clinical guidelines for cholesterol testing and clinical management of patients with high blood cholesterol. While ATP III maintains attention to intensive treatment of patients with coronary heart disease (CHD), its major new feature is a focus on primary prevention in persons with multiple risk factors. ATP III continues to identify elevated LDL cholesterol as the primary target of cholesterol lowering therapy. A basic principle of prevention is that the intensity of risk reduction therapy should be adjusted to a person's absolute risk. Risk assessment requires measurement of LDL cholesterol as part of lipoprotein analysis and identification of accompanying risk determinants (presence or absence of CHD, other clinical forms of atherosclerotic disease, diabetes, cigarette smoking, hypertension, low HDL cholesterol, family history of premature CHD, age). The category of highest risk consists of CHD and CHD risk equivalents - persons with absolute 10-year risk for major coronary events (death and myocardial infarction) >20%. The second category consists of persons with multiple (2+) risk factors in whom 10-year risk for CHD is ≥20%. Absolute risk is estimated from Framingham risk scores. The third category consists of persons having 0-1 risk factor. The LDL cholesterol goal for each category is defined and it can be achieved with dietary changes and/or drug therapy. European guidelines on cardiovascular disease (CVD) prevention in clinical practice recommend using the SCORE (Systematic COronary Risk Evaluation) Risk Charts in order to assess the risk for development of CVD, which is defined in terms of the absolute 10 year probability of developing a fatal cardiovascular event. The aim of this paper is to introduce parts of the NCEP's ATP III and European guidelines important for their implementation in laboratory practice.