Skip to main content

Screening for High Blood Cholesterol: A Risky Business

  • Chapter
Cardiovascular Disease
  • 89 Accesses

Abstract

The National Cholesterol Education Program (NCEP) has recommended blood cholesterol testing for all adults, followed by evaluation and treatment of those with high levels(1). Those with total cholesterol exceeding specified cutpoints should then undergo lipoprotein testing and, if the LDL-cholesterol also exceeds cutpoints, become candidates for intensive intervention with diet and lipid-lowering drugs. The cutpoints for intensive intervention are risk-specific, i.e., lower for those who already have coronary disease or several other risk factors in order to favor more vigorous treatment in those at higher short term risk.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Expert Panel. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 1993;269:3015–3023.

    Article  Google Scholar 

  2. Toronto Working Group. Asymptomatic Hypercholesterolemia: A Clinical Policy Review. J Clin Epidemiol 1990;43:1029–1121.

    Article  Google Scholar 

  3. Davey Smith G, Pekkanen J. Should there be a moratorium on the use of cholesterol lowering drugs? BMJ 1992;304:431–434.

    Article  PubMed  CAS  Google Scholar 

  4. Law MR, Thompson SG, Wald NJ. Assessing possible hazards of reducing serum cholesterol. BMJ 1994;308:373–379.

    Article  PubMed  CAS  Google Scholar 

  5. Muldoon M, Manuck S, Matthews K. Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. BMJ 1990;301:309–314.

    Article  PubMed  CAS  Google Scholar 

  6. Newman TB, Browner WS, Hulley SB. Childhood cholesterol screening: contraindicated. JAMA 1992;267:100–101.

    Article  PubMed  CAS  Google Scholar 

  7. Davey Smith G, Song F, Sheldon TA. Cholesterol lowering and mortality: the importance of considering initial level of risk. BMJ 1993;306:1367–1373.

    Article  Google Scholar 

  8. Rossouw J, Lewis B, Rifkind B. The value of lowering cholesterol after myocardial infarction. N Engl J Med 1990;323:1112–1119.

    Article  PubMed  CAS  Google Scholar 

  9. Rossouw JE, Canner PL, Hulley SB. Deaths from injury, violence, and suicide in secondary prevention trials of cholesterol lowering. N Engl J Med 1991;325:1813 (letter).

    Google Scholar 

  10. Coronary Drug Project Research Group. The CDP: Findings leading to further modifications of its protocol with respect to dextrothyroxine. JAMA 1972;220:996–1008.

    Article  Google Scholar 

  11. Coronary Drug Project Research Group. The CDP: Initial findings leading to modifications of its research protocol. JAMA 1970;214:1303–1313.

    Article  Google Scholar 

  12. Huttunen JK, Heinonen OP, Manninen V, et al. The Helsinki Hear Study: an 8.5-year safety and mortality follow-up. J Intern Med 1994;235:31–39.

    Article  PubMed  CAS  Google Scholar 

  13. Newman TB. Possibly disappointing results of treatment with gemfibrozil. N Engl J Med 1993;328:139–140.

    Article  PubMed  CAS  Google Scholar 

  14. Bradford RH, Shear CL, Chremos AN, et al. Expanded Clinical Evaluation of Lovastatin (EXCEL) Study results. Arch Intern Med 1991;151:43–49.

    Article  PubMed  CAS  Google Scholar 

  15. Kaplan J, Manuck S, Shively C. The effects of fat and cholesterol on social behavior in monkeys. Psychosom Med 1991;53:634–642.

    PubMed  CAS  Google Scholar 

  16. Duffy MA. Physicians’ Desk Refence, 48th Edition.Montvale, N.J.: Medical Economics Data, 1994.

    Google Scholar 

  17. Jacobs D, Blackburn H, Higgins M, etal. Report of the Conference on Low Blood Cholesterol: Mortalty Associations. Circulation 1992;86:1046–1060.

    Article  CAS  Google Scholar 

  18. Jacobs DR. Why is low blood cholesterol associated with risk of non-theroscerotic disease death? Ann Rev Pub Hlth 1993;14:95–114.

    Article  Google Scholar 

  19. Engelberg H. Low serum cholesterol and suicide. Lancet 1992;339:727–8.

    Article  PubMed  CAS  Google Scholar 

  20. Mason RP, Herbette LG, Silverman DI. Can altering serum cholesterol affect neurologic function? J Mol Cell Cardiol 1991;23:1339–1342.

    Article  PubMed  CAS  Google Scholar 

  21. Brett AS. Psychologic effects of the diagnosis and treatment of hypercholesteroloemia: lessons from case studies. Am J Med 1991;91:642–647.

    Article  PubMed  CAS  Google Scholar 

  22. Davis C, Rifkind B, Brenner H, Gordon D. A single cholesterol measurement underestimates the risk of CHD. JAMA 1990;264:3044–3046.

    Article  PubMed  CAS  Google Scholar 

  23. LRC Program. The LRC Coronary Primary Prevention Trial results, II: the relationship of reduction in incidence of CHD to cholesterol lowering. JAMA 1984;251:365–74.

    Article  Google Scholar 

  24. Tyroler H. Review of lipid-lowering clinical trials in relation to observational epidemiologic studies. Circulation 1987;76:515–522.

    Article  PubMed  CAS  Google Scholar 

  25. Oliver M. Might treatment of hypercholesterolaemia increase non-cardiac mortality? Lancet 1991;337:1529–1531.

    Article  PubMed  CAS  Google Scholar 

  26. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. In: Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston: Little, Brown, 1991: 163–167.

    Google Scholar 

  27. Eddy DM. Practice policies: Where do they come from? JAMA 1990;263:1265–1268.

    Article  PubMed  CAS  Google Scholar 

  28. Hulley SB, Newman TB, Grady D, Garber AM, Baron RB, Browner WS. Should we be measuring blood cholesterol levels in young adults? JAMA 1993;269:1416–1419.

    Article  PubMed  CAS  Google Scholar 

  29. Goldman L, Weinstein M, Goldman P, Williams L. Cost-effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of CHD. JAMA 1991;265:1145–1151.

    Article  PubMed  CAS  Google Scholar 

  30. Hunninghake DB, Stein EA, Dujovne CA, et al. The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia. N Engl J Med 1993;328:1213–1219.

    Article  PubMed  CAS  Google Scholar 

  31. Ramsay LE, Yeo WW, Jackson PR. Dietary reduction of serum cholesterol concentration: time to think again. BMJ 1991;303:953–957.

    Article  PubMed  CAS  Google Scholar 

  32. Newman TB, Garber AM, Holtzman NA, Hulley SB. Problems with the report of the Expert Panel of Blood Cholesterol Levels in Children and Adolescents. Arch Peds 1994; in press.

    Google Scholar 

  33. Hulley SB, Newman TB. Position Statement: Cholesterol screening in children is not indicated, even with positive family history. J Am Coll Nutr 1992;11:20S–22S.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1995 Springer Science+Business Media New York

About this chapter

Cite this chapter

Hulley, S.B. (1995). Screening for High Blood Cholesterol: A Risky Business. In: Gallo, L.L. (eds) Cardiovascular Disease. GWUMC Department of Biochemistry Annual Spring Symposia. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1959-1_43

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-1959-1_43

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-5805-3

  • Online ISBN: 978-1-4615-1959-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics