Screening for and treatment of hypercholesterolaemia--a review.

The screening for and treatment of hypercholesterolaemia is still a complex and controversial issue. As hypercholesterolaemia is a major risk factor for coronary heart disease (CHD), there was initially much enthusiasm for mass screening with intervention recommended for persons with serum cholesterol levels > or = 6.5 mmol/L. However, trials of treatment of hypercholesterolaemia using lipid lowering drugs showed overall benefit (i.e. reduced all-cause mortality) only for persons with pre-existing CHD (secondary prevention) or other major risk factors. For this and other reasons (e.g. cost effectiveness) screening for hypercholesterolaemia has been recommended for persons with CHD or major risk factors (family history of premature coronary heart disease, cigarette smoking, hypertension, and diabetes mellitus). Recent trials with statins have shown greater benefit than with other lipid lowering drugs, confirming the benefits of secondary prevention. In addition, one trial has shown overall benefit after 5 years for middle-aged hypercholesterolaemic males without a previous myocardial infarction, raising the possibility of mass screening. However, longer follow-up of a number of trials of primary prevention including on persons without risk factors together with a full assessment of the local situation with regards to hypercholesterolaemia is needed before mass screening can be recommended.