A secondary target of therapy introduced by ATP-III is non HDL cholesterol in patients with elevated triglycer- ides.18,24 Non HDL cholesterol is defined as the difference between total cholesterol and HDL cholesterol. It includes all cholesterol and lipoprotein particles that are considered atherogenic, including LDL cholesterol, lipoprotein, intermediate-density lipoprotein, and very-low-density lipo- protein, and is a predictor of cardiovascular death.523 Because statins lower LDL cholesterol and non HDL cholesterol to a similar extent, the relative benefits of lowering these 2 lipid measures cannot be distinguished from recent clinical trials. Fibrates could reduce the risk of coronary events in patients with high triglycerides and low HDL cholesterol levels and could have an adjunctive role in these patients in combination with statins.503,524 Nicotinic acid raises HDL cholesterol, and several trials support the efficacy of niacin when used alone or in combination with statins.504,505,525 Observational studies and treatment trials suggest that consumption of omega-3 fatty acids reduces cardiovascular risk. Cohort and case control studies have found an RR reduction of about 15% for fish consumption versus little or no fish consumption.526 In the GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell Infarto Miocardico) Preven- tion study in patients with prior MI, 1 g daily of fish oil supplement resulted in a 20% reduction in mortality at 42 months.527 Pharmacological treatment with fish oil at higher doses (2 to 4 g daily) is effective in reducing triglyceride 4.4.1.2. Blood Pressure Management Class I 1. All patients should be counseled about the need for lifestyle modification: weight control; increased physical activity; alcohol moderation; sodium reduc- tion; and emphasis on increased consumption of fresh fruits, vegetables, and low-fat dairy prod- ucts.17,529 537 (Level of Evidence: B) 2. 