Cholesterol screening is not worth while

British Medical Journal (March 7, 1998)

Testing cholesterol concentrations and treating raised concentrations while ignoring other risk factors for heart disease is unlikely to save lives and is a waste of NHS resources, according to a report from the NHS Centre for Reviews and Dissemination.

Cholesterol testing and treatment of raised concentrations with statins need to be targeted at those people with other risk factors of coronary heart disease, according to the report's author, Professor Trevor Sheldon. He says that testing and treatment are not appropriate for people whose only risk factor is a raised cholesterol concentration.

Cholesterol screening would misclassify many people and may have damaging psychological effects (Effective Health Care Bulletin 1998;4(1)).

Blood cholesterol concentration alone is a relatively poor predictor of who will have a coronary heart disease event. Among British men aged 40-59, the distribution of blood cholesterol concentrations in those who went on to develop coronary heart disease overlapped considerably with the distribution in those who did not (figure omitted). Yet spending on cholesterol lowering drugs has risen more than fivefold since 1993, to £113m ($184m) last year. "The study shows that it is important not to fetishise the cholesterol level as an indication of risk but to look at the whole range of risk factors - for example, smoking and exercise," said Professor Sheldon.

Some people who have had a myocardial infarction are not being treated appropriately, he added. They are still smoking, not being treated for hypertension, and not being given aspirin. He said that cholesterol lowering treatment should be restricted to those people who are at sufficiently high risk of coronary heart disease - namely, those who have had a myocardial infarction, have undergone revascularisation, or have diabetes and other risk factors.

Professor Barry Lewis, chairman of the international task force on prevention of coronary heart disease, said that while he agreed that a raised cholesterol concentration should be considered alongside other risk factors for coronary heart disease, it was undoubtedly one of the most important.

Zosia Kmietowicz

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