[Cholesterol measurement as a screening test: a category error]

The measurement of cholesterol levels is a routinely used test which, is claimed to be also a screening test. However, true screening for familial hypercholesterolemia in young people must be distinguished from the so-called risk factor screening among adults, which in Germany is performed both systematically in the whole population and even more so incidentally. This risk factor approach to the measurement of cholesterol is neither a screening test nor does it aim to detect a disease early, but the rationale is a risk factor medicine approach, which has to be evaluated according to its own requirements. The technical efficiency of cholesterol measurement as a screening test is so low, that the notion of screening represents a misnomer and a category error. The measurement of risk factors in a screening context and as a method of individual primary preventive medicine has led to unsolvable problems. A consensus has been achieved, that only a multiple risk factor approach is worthwhile, though the individual and the community approach are both only marginally effective in primary prevention, as has been shown in meta-analyses. Prescription for chemoprophylaxis with statins has shown a relevant risk reduction, but has only been evaluated as a high-risk approach with a cardiovascular risk of 2-3% per year.