[Effectiveness of hypercholesterolemia detection in high risk individuals compared to opportunistic detection]

The aims of this study were to estimate the number of people who should receive some intervention (pharmacologic and/or dietetic) to reduce cholesterol concentrations and to evaluate selective case finding in comparison to opportunistic detection.

Six hundred twenty-five individuals participating in a study of cardiovascular risk factors were included in the study. Those with total cholesterol concentrations (TC) greater than 6.2 mmol/l and those with CT concentrations greater than 5.2 mmol/l observed upon lipid profile analysis and history of cardiovascular disease and/or risk factors were considered as candidates. Out of these individuals, those with cholesterol concentrations linked to low density lipoproteins greater than 4.14 mmol/l or greater than 3.37 mmol/l and previous history of cardiovascular disease or two risk factors were considered candidates to undergo intervention to reduce cholesterol concentrations. Moreover, the number of individuals with CT concentrations greater than 6.2 mmol/l which would not be detected if CT was only determined in those who already had another cardiovascular risk factor was estimated.

37.5% (CI 95%; 33.8%-41.5%) of the individuals required lipid profile and out of these 88.8% (CI 95%; 3.8%-92.4%) were candidates to receive intervention. Upon evaluating the efficacy of the strategy of selective case finding it was observed that the sensitivities of the risk factors were low, ranging from 22.6% in those with family history of cardiovascular disease to 34.8% in cases with personal history of high blood pressure.

If selective case finding of high risk subjects was the only strategy applied, many individuals with hypercholesterolemia would remain undetected, therefore the strategy of opportunistic detection is preferable whenever possible.