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Am Fam Physician. 2001;64(1):21-22

NCEP Issues New Cholesterol Guidelines

The National Cholesterol Education Program (NCEP), which is coordinated by the National Heart, Lung, and Blood Institute (NHLBI), recently unveiled new clinical practice guidelines on the prevention and management of high cholesterol levels in adults. Key changes to the guidelines, the first changes since 1993, include the following: treating high cholesterol levels more aggressively in patients with diabetes; the use of a lipoprotein profile as the first test for high cholesterol levels; a new level at which low high-density lipoprotein (HDL) levels become a major risk factor for heart disease; a new set of “Therapeutic Lifestyle Changes”; and an increased attention to the treatment of high triglyceride levels. The updated guidelines are expected to substantially increase the number of Americans being treated for high cholesterol level. The full-length guidelines, titled “Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel, III Executive Summary), is available online at

New Clinical Trial to Investigate Treatment Options for Breast Cancer

The National Surgical Adjuvant Breast and Bowel Project (NSABP), in conjunction with Pharmacia, has announced a new Phase III clinical trial that will evaluate whether exemestane (Aromasin) will prolong disease-free survival and overall survival by preventing, reducing or inhibiting recurrent tumor growth in high-risk breast cancer patients. In the study, 3,000 women diagnosed with estrogen-receptor-positive breast cancer from over 100 sites in the United States, Canada and Puerto Rico will be randomized to receive either 25 mg of exemestane or placebo daily for two years. Women are eligible to participate in the study if they are postmenopausal, disease-free after receiving tamoxifen (Nolvadex) for 4.9 to 5.5 years, and have a history of a primary tumor that was hormone receptor-positive. Exemestane is currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced breast cancer in postmenopausal women whose tumors have stopped responding to tamoxifen. The most commonly reported side effects of exemestane are mild to moderate hot flushes, nausea and fatigue. For more information on this trial, call the National Cancer Institute's Cancer Information Service at 800–4-CANCER or visit the NSABP Web site at

CDC Advises Physicians to Order Influenza Vaccine Early

The Centers for Disease Control and Prevention (CDC) is advising physicians to order the influenza vaccine immediately for patients at high-risk of influenza-related complications to avoid delays in delivery similar to last year. The CDC also recommends that physicians and public health organizations that administer influenza vaccine develop contingency plans in case of another supply shortage. Each season's influenza vaccine is newly produced for each influenza. The trivalent vaccine prepared for the 2001–2002 season will include A/Moscow/10/99 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like and B/Sichuan/379/99-like antigens. Pre-orders of the vaccine will cost $4 to $5 per dose, an increase of 50 to 100 percent from last year's pre-order prices. More information on the prevention and control of influenza this year is available in the April 20, 2001, issue of Morbidity and Mortality Weekly Report (Recommendations and Report series no. 4).

Web Site Offers Patients and Physicians Information About High Blood Pressure

The National Heart, Lung, and Blood Institute (NHLBI) has added a new feature to its Web site, called “Your Guide to Lowering Blood Pressure,” which is intended to educate patients about how to prevent and control high blood pressure. The Web site ( includes: current and practical information about high blood pressure; tips and interactive quizzes about high blood pressure and heart health; information about various medications; high blood pressure keyword topics; healthy recipes; and tips on diet and exercise. The site also has a section for physicians to keep up-to-date with clinical information and the latest recommendations in the prevention, detection and treatment of high blood pressure.

CDC Recommends Deferral of Adult/Adolescent Td Boosters Until 2002

The CDC recently announced interim recommendations advising the delay of all routine tetanus and diphtheria toxoid (Td) boosters in adults and adolescents until 2002 because of a shortage created when one of the two manufacturers of tetanus toxoid-containing products discontinued production. Td use should follow existing recommendations for all other indications, including: persons traveling to a country where the risk of diphtheria is high; persons requiring tetanus vaccination for prophylaxis in wound management; persons who have received less than three doses of any vaccine containing Td; and pregnant women who have not been vaccinated with Td during the preceding 10 years. The CDC recommends that clinicians record the names of patients whose booster dose is delayed during the shortage, and that these patients be notified to receive the booster when the Td supplies are restored. Aventis Pastuer, now the sole manufacturer of tetanus and Td in the United States, expects to fulfill the complete national demand for tetanus-containing vaccines by early 2002. Currently, the company is rationing Td vaccine by evaluating orders based on the interim CDC recommendations and the available vaccine supply. For more information, contact Aventis Pasteur at 800-VACCINE (822–2463) or visit their Web site at

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Copyright © 2001 by the American Academy of Family Physicians.

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