Screening for cardiovascular disease with cholesterol.

BACKGROUND: Total cholesterol (TC) and lipoprotein measurements are among the major risk factors for cardiovascular disease (CVD). ISSUES: The massive (and increasing) disease burden associated with cardiovascular disorders justifies public health measures, such as screening, which may assist with the identification and treatment of individuals who have a high risk of developing these disorders. Whole populations are placed at risk by environmental factors such as dietary habits and exercise patterns, and this may be reflected by simple tests such as TC that largely depend on dietary consumption of saturated fat and cholesterol. On the other hand, identification of high-risk individuals within populations requires more specific tests such as measurement of cholesterol in lipoprotein fractions. This recognizes that the contribution of different risk factors may vary between individuals. Dietary and pharmacological interventions, particularly those that reduce low-density lipoprotein cholesterol (LDL-C), have been shown to prevent the onset or recurrence of CVD.
CONCLUSIONS: It is desirable and justifiable to try to identify high-risk patients before the onset of clinical CVD because morbidity and mortality may occur as a consequence of the initial event. The relationship between the costs and the benefits of prophylactic interventions varies according to the extent to which clinical procedures, including laboratory testing, can estimate the level of cardiovascular risk. It can be argued that inappropriate cholesterol screening may have a negative effect on health economics and patient attitudes, but these problems appear easily surmountable. Techniques that enable the preclinical detection of CVD may help the process to strike a balance between public health initiatives that reduce the environmental factors responsible for the epidemic of CVD, and the strategies that are known to reduce event rates in high-risk individuals.