title: Relationship between cardiovascular risk and lipid testing in one health care system: a retrospective cohort study.
abstract: BACKGROUND
  The US Preventive Services Taskforce (USPSTF) recommends routine lipid screening beginning age 35 for men [1]. For women age 20 and older, as well as men age 20-34, screening is recommended if cardiovascular risk factors are present. Prior research has focused on underutilization but not overuse of lipid testing. The objective is to document over- and under-use of lipid testing in an insured population of persons at low, moderate and high cardiovascular disease (CVD) risk for persons not already on statins.
  
  
  METHODS
  The study is a retrospective cohort study that included all adults without prior CVD who were continuously enrolled in a large integrated healthcare system from 2005 to 2010. Measures included lipid test frequency extracted from administrative data and Framingham cardiovascular risk equations applied using electronic medical record data. Five year lipid testing patterns were examined by age, sex and CVD risk. Generalized linear models were used to estimate the relative risk for over testing associated with patient characteristics.
  
  
  RESULTS
  Among males and females for whom testing is not recommended, 35.8 % and 61.5 % received at least one lipid test in the prior 5 years and 8.4 % and 24.4 % had two or more. Over-testing was associated with age, race, comorbidity, primary care use and neighborhood income. Among individuals at moderate and high-risk (not already treated with statins) and for whom screening is recommended, between 21.4 % and 25.1 % of individuals received no screening in the prior 5 years.
  
  
  CONCLUSIONS
  Based on USPSTF lipid screening recommendations, this study documents substantial over-testing among individuals with low CVD risk and under-testing among individuals with moderate to high-risk not already on statins. Opportunity exists to better focus lipid screening efforts appropriate to CVD risk.
authors.affiliation: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98122, USA. reid.rj@ghc.org.|Group Health Physicians, Seattle, WA, USA. reid.rj@ghc.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
authors.affiliation: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98122, USA. anderson.mellissa@ghc.org.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Anderson
authors.affiliation: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98122, USA. fishman.p@ghc.org.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fishman
authors.affiliation: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98122, USA. mcclure.j@ghc.org.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: McClure
authors.affiliation: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98122, USA. johnson.rl@ghc.org.
authors.forename: Ron L
authors.initials: RL
authors.lastname: Johnson
authors.affiliation: Betty Irene Moore School of Nursing, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA. scatz@ucdavis.edu.
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Catz
authors.affiliation: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98122, USA. green.b@ghc.org.|Group Health Physicians, Seattle, WA, USA. green.b@ghc.org.
authors.forename: Beverly B
authors.initials: BB
authors.lastname: Green
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008055:Lipids / Q000097:blood*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D019982:Organizational Case Studies; D011320:Primary Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D014861:Washington
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids