Authors' objectives:

To examine the evidence about the benefits and harms of screening and treatment of lipid disorders in adults, adolescents, and children.

Authors' results and conclusions: There is strong, direct evidence that drug therapy reduces coronary heart disease (CHD) events and CHD mortality in middle-aged men (35 to 70 years of age) with abnormal lipids and a potential risk of CHD events greater than 1%per year. Drug therapy may also reduce total mortality in patients at higher risk (greater than 1.5% per year). Less direct evidence suggests that drug therapy is also effective in other adults, including older men (over the age of 70 years) and middle-aged and older women (ages 45 years and older) with similar levels of risk. Trials of diet therapy for primary prevention have led to long-term reductions in cholesterol of 3% to 6%but have not demonstrated a reduction in CHD events overall. Exercise programs that maintain or reduce body weight can produce short-term reductions in total cholesterol of 3% to 6% but longer-term results in unselected populations have found small reductions or no effect. Screening middle-aged and older men and women for lipid disorders can accurately identify persons at increased CHD risk who may benefit from therapy. The evidence is insufficient about benefits and harms of screening and treating persons at low absolute risk, including most men under 35 years of age, women under 45 years, and children and adolescents. To identify accurately persons with abnormal lipids, at least 2 measurements of total cholesterol and high-density lipoprotein cholesterol (HDL) are required. The role of measuring triglycerides and the optimal screening interval are unclear from the available evidence.

Authors' recommendations: Strong evidence shows the effectiveness of therapy for lipid disorders in middle-aged men; indirect evidence shows effectiveness in older men and women of sufficient risk. Screening for lipid disorders with total cholesterol and HDL and performing a global assessment of CHD risk can accurately identify those at sufficient risk who can benefit from treatment.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspschol.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)