Screening for lipid disorders
- Sandeep Vijan, MD
Sandeep Vijan, MD
- Professor of Internal Medicine
- University of Michigan
- Section Editors
- Mason W Freeman, MD
Mason W Freeman, MD
- Section Editor — Lipids
- Professor of Medicine
- Harvard Medical School
- Joann G Elmore, MD, MPH
Joann G Elmore, MD, MPH
- Editor-in-Chief — Primary Care (Adult)
- Section Editor — General Medicine
- Professor of Medicine, Adjunct Professor of Epidemiology
- University of Washington School of Medicine
Screening for lipid abnormalities is widely recommended and practiced in industrialized nations. While a narrow view of screening would suggest that evaluation for dyslipidemia is primarily aimed at identifying those who are candidates for lipid-lowering therapy, a more appropriate view is that lipid testing provides one component of the assessment of overall cardiovascular risk and helps to identify those who are likely to benefit from any of several different interventions, such as aspirin and antihypertensive therapy, that lower cardiovascular risk. Lipid-lowering therapy, at least with statins, is one key component of a comprehensive plan to improve cardiovascular outcomes. (See "Overview of primary prevention of coronary heart disease and stroke".)
Generally, screening programs rely on several key features. The disease being identified early (or prevented) needs to be serious, pre-clinical conditions should be common and asymptomatic, and early treatment should have proven benefit (see "Evidence-based approach to prevention") . These conditions are all met in the case of lipid screening:
●Coronary heart disease (CHD) and related conditions, such as stroke, are the most common cause of morbidity and mortality in industrialized nations [2,3].
●Dyslipidemia is typically asymptomatic, but is common and an important predictor of CHD risk [4,5].
●There are a variety of treatments that are effective in lowering the risk of primary CHD risk [6,7].
- Willson JJ. Principles and practice of screening for disease. World Health Organization: Geneva 1968.
- Keenan NL, Shaw KM, Centers for Disease Control and Prevention (CDC). Coronary heart disease and stroke deaths - United States, 2006. MMWR Suppl 2011; 60:62.
- Centers for Disease Control and Prevention (CDC). Coronary heart disease mortality trends among whites and blacks--Appalachia and United States, 1980-1993. MMWR Morb Mortal Wkly Rep 1998; 47:1005.
- Manolio TA, Pearson TA, Wenger NK, et al. Cholesterol and heart disease in older persons and women. Review of an NHLBI workshop. Ann Epidemiol 1992; 2:161.
- Kannel WB. Some lessons in cardiovascular epidemiology from Framingham. Am J Cardiol 1976; 37:269.
- Ward S, Lloyd Jones M, Pandor A, et al. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess 2007; 11:1.
- Cholesterol Treatment Trialists' (CTT) Collaborators, Mihaylova B, Emberson J, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380:581.
- Rosen AB, Cutler DM, Norton DM, et al. The value of coronary heart disease care for the elderly: 1987-2002. Health Aff (Millwood) 2007; 26:111.
- Jackson R, Lawes CM, Bennett DA, et al. Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk. Lancet 2005; 365:434.
- National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106:3143.
- Castelli WP. Cholesterol and lipids in the risk of coronary artery disease--the Framingham Heart Study. Can J Cardiol 1988; 4 Suppl A:5A.
- Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 1986; 256:2823.
- Musunuru K. Atherogenic dyslipidemia: cardiovascular risk and dietary intervention. Lipids 2010; 45:907.
- Yang Q, Cogswell ME, Flanders WD, et al. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults. JAMA 2012; 307:1273.
- Farzadfar F, Finucane MM, Danaei G, et al. National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3·0 million participants. Lancet 2011; 377:578.
- Cannon CP. The IDEAL cholesterol: lower is better. JAMA 2005; 294:2492.
- Hayward RA, Hofer TP, Vijan S. Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem. Ann Intern Med 2006; 145:520.
- Hayward RA, Krumholz HM, Zulman DM, et al. Optimizing statin treatment for primary prevention of coronary artery disease. Ann Intern Med 2010; 152:69.
- Helfand M, Carson S. Screening for Lipid Disorders in Adults: Selective Update of 2001 US Preventive Services Task Force Review. Agency for Healthcare Research and Quality; Rockland, MD 2008.
- Arsenault BJ, Boekholdt SM, Kastelein JJ. Lipid parameters for measuring risk of cardiovascular disease. Nat Rev Cardiol 2011; 8:197.
- Ingelsson E, Schaefer EJ, Contois JH, et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA 2007; 298:776.
- Emerging Risk Factors Collaboration, Di Angelantonio E, Sarwar N, et al. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 2009; 302:1993.
- Boekholdt SM, Arsenault BJ, Mora S, et al. Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis. JAMA 2012; 307:1302.
- Ip S, Lichtenstein AH, Chung M, et al. Systematic review: association of low-density lipoprotein subfractions with cardiovascular outcomes. Ann Intern Med 2009; 150:474.
- Ramjee V, Sperling LS, Jacobson TA. Non-high-density lipoprotein cholesterol versus apolipoprotein B in cardiovascular risk stratification: do the math. J Am Coll Cardiol 2011; 58:457.
- Emerging Risk Factors Collaboration, Di Angelantonio E, Gao P, et al. Lipid-related markers and cardiovascular disease prediction. JAMA 2012; 307:2499.
- Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2292.
- D'Agostino RB Sr, Grundy S, Sullivan LM, et al. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA 2001; 286:180.
- Cooper GR, Myers GL, Smith SJ, Schlant RC. Blood lipid measurements. Variations and practical utility. JAMA 1992; 267:1652.
- Glasziou PP, Irwig L, Heritier S, et al. Monitoring cholesterol levels: measurement error or true change? Ann Intern Med 2008; 148:656.
- Sidhu D, Naugler C. Fasting time and lipid levels in a community-based population: a cross-sectional study. Arch Intern Med 2012; 172:1707.
- Craig SR, Amin RV, Russell DW, Paradise NF. Blood cholesterol screening influence of fasting state on cholesterol results and management decisions. J Gen Intern Med 2000; 15:395.
- Fukuyama N, Homma K, Wakana N, et al. Validation of the Friedewald Equation for Evaluation of Plasma LDL-Cholesterol. J Clin Biochem Nutr 2008; 43:1.
- Nordestgaard BG, Benn M. Fasting and nonfasting LDL cholesterol: to measure or calculate? Clin Chem 2009; 55:845.
- Doran B, Guo Y, Xu J, et al. Prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol levels on long-term mortality: insight from the National Health and Nutrition Examination Survey III (NHANES-III). Circulation 2014; 130:546.
- Eckel RH. LDL cholesterol as a predictor of mortality, and beyond: to fast or not to fast, that is the question? Circulation 2014; 130:528.
- Carroll MD, Lacher DA, Sorlie PD, et al. Trends in serum lipids and lipoproteins of adults, 1960-2002. JAMA 2005; 294:1773.
- Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:S49.
- RELATIONSHIP BETWEEN LIPIDS AND CHD RISK
- Whom to test
- - Higher risk
- - Lower risk
- Estimating the probability of cardiovascular events
- Choice of tests
- Frequency of testing
- Stopping screening
- RECOMMENDATIONS OF OTHERS
- SUMMARY AND RECOMMENDATIONS