Choice and use of blood lipid tests. An epidemiologic perspective

Serum cholesterol is a useful test in asymptomatic adults who are interested in preventing coronary heart disease (CHD). It guides the decision to recommend a fat-controlled diet to reduce the serum cholesterol level; this intervention probably decreases the risk of CHD in patients with high levels (eg, greater than 240 mg/dL), but not in those with lower levels (the majority). The potential effect of such intervention on absolute (attributable) CHD risk is relatively large in males and in patients with other risk factors. Dietary intervention probably has less effect on CHD risk than eliminating smoking or controlling hypertension. Lipid and lipoprotein tests other than cholesterol are not generally needed, although high-density lipoprotein cholesterol may be useful in certain situations. These epidemiologic considerations, tempered by the preferences of the patient, are useful for individualizing preventive medicine decisions.