Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors.
OBJECTIVE
To compare the implications of four widely used cholesterol screening and treatment guidelines by applying them to a population in the United Kingdom.


METHODS
Guidelines were applied to population based data from a cross sectional study of cardiovascular disease and risk factors.


METHODS
Newcastle upon Tyne, United Kingdom.


METHODS
General population sample (predominantly of European origin) of 322 men and 319 women aged 25-64 years.


METHODS
Proportions recommended for screening and treatment.


METHODS
Criteria from the British Hyperlipidaemia Association, the British Drugs and Therapeutics Bulletin (which used the Sheffield table), the European Atherosclerosis Society, and the American national cholesterol education programme were applied to the population.


RESULTS
Proportions recommended for treatment varied appreciably. Based on the British Drugs and Therapeutics Bulletin guidelines, treatment was recommended for 5.3% (95% confidence interval 2.9% to 7.7%) of men and 3.3% (1.5% to 5.3%) of women, while equivalent respective values were 4.6 (2.3 to 6.9) and 2.8 (1.0 to 4.6) for the British Hyperlipidaemia Association, 23% (18.4% to 27.6%) and 10.6% (7.3% to 14.0%) for the European Atherosclerosis Society, and 37.2% (31.9% to 42.5%) and 22.2% (17.6% to 26.8%) for the national cholesterol education programme. Only the British Hyperlipidaemia Association and Drugs and Therapeutics Bulletin guidelines recommend selective screening. Applying British Hyperlipidaemia Association guidelines, from 7.1% (4.3% to 9.9%) of men in level one to 56.7% (51.3% to 62.1%) of men in level three, and from 4.4% (2.1% to 6.7%) of women in level one to 54.4% (48.9% to 59.9%) of women in level three would have been recommended for cholesterol screening. Had the Drugs and Therapeutics Bulletin guidelines been applied, 22.2% (16.5% to 27.9%) of men and 12.2% (8. 6% to 15.8%) of women would have been screened.


CONCLUSIONS
Without evidence based guidelines, there are problems of variation. A consistent approach needs to be developed and agreed across the United Kingdom.
Department of Medicine, University of Newcastle, Medical School, Newcastle NE2 4HH. n.c.unwin@ncl.ac.uk
N
N
Unwin
R
R
Thomson
A M
AM
O'Byrne
M
M
Laker
H
H
Armstrong
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D006113:United Kingdom
D002784:Cholesterol