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Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: Cross sectional study of cardiovascular disease and risk factors

Lookup NU author(s): Professor Nigel Unwin, Emeritus Professor Richard Thomson, Dr Michael Laker



Objective: To compare the implications of four widely used cholesterol screening and treatment guidelines by applying them to a population in the United Kingdom. Design: Guidelines were applied to population based data from a cross sectional study of cardiovascular disease and risk factors. Setting: Newcastle upon Tyne, United Kingdom. Subjects: General population sample (predominantly of European origin) of 322 men and 319 women aged 25-64 years. Main outcome measures: Proportions recommended for screening and treatment. Methods: Criteria from the British Hyperlipidaemia Association, the British Drugs and Therapeutics Bulletin (which used the Sheffield table), the European Atherosclerosis Society, and the American national cholesterol education programme were applied to the population. Results: Proportions recommended for treatment varied appreciably. Based on the British Drugs and Therapeutics Bulletin guidelines, treatment was recommended for 5.3% (95%0 confidence interval 2.9% to 7.7%) of men and 3.3% (1.5% to 5.3%) of women, while equivalent respective values were 4.6 (2.3 to 6.9) and 2.8 (1.0 to 4.6) for the British Hyperlipidaemia Association, 23% (18.4% to 27.6%) and 10.6% (7.3% to 14.0%) for the European Atherosclerosis Society, and 37.2% (31.9% to 42.5%) and 22.2% (17.6% to 26.8%) for the national cholesterol education programme. Only the British Hyperlipidaemia Association and Drugs and Therapeutics Bulletin guidelines recommend selective screening. Applying British Hyperlipidaemia Association guidelines, from 7.1% (4.3% to 9.9%) of men in level one to 56.7% (51.3% to 62.1%) of men in level three, and from 4.4% (2.1% to 6.7%) of women in level one to 54.4% (48.9% to 59.9%) of women in level three would have been recommended for cholesterol screening. Had the Drugs and Therapeutics Bulletin guidelines been applied, 22.2% (16.5% to 27.9%) of men and 12.2% (8.6% to 15.8%) of women would have been screened. Conclusions: Without evidence based guidelines, there are problems of variation. A consistent approach needs to be developed and agreed across the United Kingdom.

Publication metadata

Author(s): Unwin N, Thomson R, O'Byrne AM, Laker M, Armstrong H

Publication type: Article

Publication status: Published

Journal: British Medical Journal

Year: 1998

Volume: 317

Issue: 7166

Pages: 1125-1130

Print publication date: 24/10/1998

Date deposited: 22/11/2010

ISSN (print): 0959-8138

ISSN (electronic): 1756-1833

Publisher: BMJ Group


PubMed id: 9784450