Screening for coronary heart disease risk in the elderly: total cholesterol versus high-density...

Despite recent national recommendations to use total cholesterol (TC) measures to screen patients for hyperlipidemia and coronary heart disease (CHD) risk, it is unclear how predictive this approach is for older adults, who tend to have higher high-density lipoprotein-cholesterol (HDL-C) values and therefore higher TC. We looked at lipid profiles of 190 adults with a mean age of 70.8 years (range 51 to 86 years) to determine the value of TC in predicting risk states based on HDL-C. One hundred sixty-two did not have a diagnosis of CHD; 28 had a diagnosis of CHD. Of those subjects without CHD, 13 (8.0%) with a TC under 200 mg/dL were "underscreened" since they had a low HDL-C value under 40 mg/dL. Men were three times more likely to be underscreened on the basis of TC alone. Thirty (18.5%) of the subjects were "overscreened" since they had a TC greater than or equal to 240 mg/dL and a normal HDL-C value greater than 50 mg/dL. Only women were overscreened. For those 28 subjects with CHD, TC values alone also "underscreened" 3 (10.7%) of this cohort, and "overscreened" 3 (10.7%). If a provider decides to screen for hyperlipidemia and CHD risk in older patients, a lipid profile rather than a nonfasting TC test should be ordered. Over 26% of the patients in this study would have been misclassified and inappropriately advised regarding their risk for CHD based on a TC value alone.