[Benefits and costs of early detection and treatment of hypercholesterolemia]

Hypercholesterolemia is the epidemiologically most relevant parameter of hyperlipoproteinemia 1) for its high prevalence of almost 40% > = 250 mg/dl in the adult German population (30-65 years) and 2) because of a relative risk of 3 and more for coronary heart disease. An estimate of the cost to benefit relation of early diagnosis and therapy requires epidemiological, clinical, and economic analysis. A synopsis of the present scientific discussion leads to more restricted recommendations for treatment than before, i.e., limited to males aged 40-65, of high cardiovascular risk and cholesterol of at least > = 250 mg/dl. An even more conservative approach especially with regard to screening programs is not justified yet. However, careful monitoring of forthcoming trials and meta-analyses is mandated. The costs for an indicated cholesterol-lowering medication are not extreme, but there are large differences between different drugs on the German market. Overtreatment of the aged population occurs together with undertreatment of hypercholesterolemic men of medium age.