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 i n the United Kingdom. Design: Guidelines were applied to population ba sed data from a ness sectional study of cardiovascular disease and ris k factors. Setting: Newcastle upon Tyne, United Kingdom. Subjects: Gen eral population sample (predominantly of European origin) of 322 men a nd 319 women aged 25-64 years. Main outcome measures: Proportions reco mmended for screening and treatment. Methods: Criteria from the Britis h Hyperlipidaemia Association, the British Drugs and Therapeutics Bull etin (which used the Sheffield table), the European Atherosclerosis So ciety, and the American national cholesterol education programme were applied to the population. Results: Proportions recommended far treatm ent varied appreciably. Based on the British Drugs and Therapeutics Bu lletin 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%) an d 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 chol esterol education programme. Only the British Hyperlipidaemia Associat ion and Drugs and Therapeutics Bulletin guidelines recommend selective screening. Applying British Hyperlipidaemia Association guidelines, f rom 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: Wi thout evidence based guidelines, there are problems of variation. A co nsistent approach needs to be developed and agreed across the United K ingdom.