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Screening and treating adults for lipid disorders.
M P Pignone1, C J Phillips, D Atkins
1Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. pignone@med.unc.edu
American Journal of Preventive Medicine
|April 18, 2001
Summary
Screening for lipid disorders effectively identifies individuals at high risk for coronary heart disease (CHD) events, particularly middle-aged adults. Treatment with medication significantly reduces CHD events and mortality in these populations.
Area of Science:
- Cardiovascular Medicine
- Preventive Cardiology
- Public Health
Background:
- Lipid disorder screening and treatment are widely accepted for high-risk individuals, but controversial for low to medium-risk populations.
- Coronary heart disease (CHD) remains a significant public health concern, necessitating effective preventive strategies.
Purpose of the Study:
- To evaluate the evidence on the benefits and harms of screening and treating lipid disorders in adults without pre-existing cardiovascular disease.
- To inform guidelines for the U.S. Preventive Services Task Force regarding lipid management.
Main Methods:
- Comprehensive literature search of MEDLINE (1994-1999), systematic reviews, and peer-reviewed articles.
- Inclusion of studies on drug therapy, diet, exercise, and screening for lipid disorders.
- Ensured completeness through hand searching and expert review.
Main Results:
- Drug therapy strongly reduces CHD events and mortality in middle-aged men (35-65) with abnormal lipids and elevated CHD risk (>1-2% per year).
- Evidence is insufficient for benefits/harms of treating younger adults (<35 men, <45 women) with lipids but low CHD risk.
- Diet and exercise show modest short-term cholesterol reductions but lack proven long-term CHD event reduction.
Conclusions:
- Screening for lipid disorders is effective in middle-aged/older adults and younger individuals with additional cardiovascular risk factors.
- Accurate screening tests and effective treatments support the role of lipid disorder screening in primary prevention.
- Further research is needed on optimal screening intervals and triglyceride measurement.