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Comparison of methods to identify individuals at increased risk of coronary disease from the general population
S Wilson1, A Johnston, J Robson
1Clinical Pharmacology, William Harvey Research Institute, Barts and The London, Queen Mary's School of Medicine and Dentistry, London EC1M 6BQ. s.l.wilson@qmul.ac.uk
Insights
Identifying high-risk individuals for coronary heart disease is crucial. A simple strategy of measuring cholesterol in everyone aged 50 and over efficiently identifies those at high risk.
Area of Science:
- Cardiovascular epidemiology
- Public health screening
- Health policy evaluation
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality globally.
- Effective identification strategies are needed to target preventative interventions.
- National guidelines exist for CHD risk assessment, but their efficiency is debated.
Purpose of the Study:
- To evaluate the National Service Framework (NSF) guidelines for cholesterol measurement in CHD risk assessment.
- To compare the NSF criteria with alternative strategies for identifying high-risk individuals in the general population.
Main Methods:
- A comparative analysis of four strategies was performed using data from the Health Survey for England 1998.
- The strategies included NSF criteria, Sheffield tables, an age threshold of 50 years, and estimated risk assessment using fixed cholesterol values.
- The study population comprised 6307 adults aged 30-74 without prior cardiovascular events.
Main Results:
- The NSF guidelines identified 81.2% of high-risk individuals while selecting 43.4% of the population for cholesterol measurement.
- The Sheffield tables identified 99.91% of high-risk individuals but required cholesterol measurement in 73.1% of the population.
- An age threshold of 50 years identified 92.8% of high-risk individuals, necessitating cholesterol measurement in 46.3% of the population.
- Estimated risk assessment using fixed cholesterol values was less effective, identifying only 75.9% of high-risk individuals while requiring measurement in 17.8%.
Conclusions:
- Measuring cholesterol in all individuals aged 50 and over is a straightforward and effective method for identifying high-risk coronary heart disease cases.
- This age-based strategy offers a practical approach to population screening for cardiovascular risk.
- Simpler screening methods may be more efficient for public health interventions compared to complex risk calculators.
Objectives:
To evaluate the guidelines on measurement of cholesterol in the national service framework for coronary heart disease and to compare alternative strategies for identifying people at high risk of coronary disease in the general population.
Design:
Comparison of methods (national service framework criteria, Sheffield tables, age threshold of 50 years, estimated risk assessment using fixed cholesterol values) for identifying people with a 10 year coronary event risk of 15% or greater.
Setting:
Health survey for England 1998.
Subjects:
6307 people aged between 30 and 74 years with no history of myocardial infarction, stroke, or angina.
Main Outcome Measures:
Proportion of the total population selected for measurement of cholesterol and proportion of people at 15% or greater risk identified.
Results:
The national service framework guidelines selected 43.4% (95% confidence interval 42.2% to 44.6%) of the study population for cholesterol measurement and identified 81.2% (80.2% to 82.2%) of those at 15% or greater risk. The Sheffield tables selected 73.1% (72.0% to 74.2%) for cholesterol measurement and identified 99.91% (99.83% to 99.99%) of those at 15% or greater risk. An age threshold of 50 years selected 46.3% (45.1% to 47.5%) for cholesterol measurement and identified 92.8% (92.1% to 93.4%) of those at 15% or greater risk. Estimated risk assessments using fixed cholesterol values selected 17.8% (16.8% to 18.7%) for cholesterol measurement and identified 75.9% (74.8% to 76.9%) of those at 15% or greater risk.
Conclusion:
Measuring the cholesterol concentration of everyone aged 50 years and over is a simple and efficient method of identifying people at high risk of coronary disease in the general population.
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