Purpose:

Both the US Preventive Services Task Force (USPSTF) and the National Cholesterol Education Program (NCEP ATP III) have issued recommendations on screening for dyslipidemia in adults. To guide the USPSTF in updating its 2001 recommendations, we reviewed evidence relevant to discrepancies between these recommendations.

Data Sources:

A 2001 evidence review prepared for the USPSTF, supplemented by searches of the Cochrane Library, MEDLINE, EMBASE, and reference lists of recent systematic reviews.

Study Selection:

Randomized controlled trials and observational studies published between December 1999 and February 2005 that addressed screening in younger patients not at high risk; use of triglyceride levels in an initial screening panel; optimal screening intervals; selection of patients for treatment; and harms of drug therapy.

Data Extraction:

We abstracted data on the design, results, and quality of each included trial. We used standard USPSTF methods to rate the internal validity of trials and epidemiologic studies.

Data Synthesis:

New evidence relevant to discrepancies between USPSTF and ATP III recommendations was summarized in the context of earlier evidence.

Limitations:

This document should be read in conjunction with the full systematic evidence review conducted for the USPSTF in 2001, the final report of ATP III, and the 2004 ATP III update.

Conclusions:

There is no new evidence relevant to screening younger adults or to appropriate screening intervals. Evidence is conflicting regarding the additional contribution of a serum triglyceride level to the identification of individuals at short-term risk for coronary heart disease events. The balance of benefits and harms is clearly in favor of statin therapy among individuals enrolled in some, but not all, randomized trials of primary prevention. The long-term harms of statin therapy are unknown.

Contents

• 1. Introduction
• 2. Methods
  • Data Sources
  • Study Selection
  • Data Extraction and Quality Assessment
  • Data Synthesis and Analysis
  • Funding
• 3. Results
  • Key Question 1. How frequent is elevated total cholesterol in men younger than age 35 and women younger than age 40, and what proportion have an overall 10-year risk of cardiac events of 10% or greater?
  • Key Question 2. What evidence supports the use of triglyceride levels as part of an initial screening panel?
  • Key Question 3. What are the optimal screening intervals in the general population and in patients at high risk for CHD events?
  • Key Question 4. What risk factors should be used to select patients for drug therapy?
  • Key Question 5. What is the current evidence about the harms of drug therapy for lipid disorders?
• 4. Limitations and Conclusions
• Appendix 1. Search Strategy
• Appendix 2. U.S. Preventive Services Task Force Quality Rating Criteria
• Appendix 3. Selected Evidence from the May 2003 AHRQ Evidence Reporta on the Diagnosis and Treatment of Coronary Heart Disease in Women
• References

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Mark Helfand, Director, helfand/at/ohsu.edu; Susan Carson, Senior Research Associate, carsons/at/ohsu.edu.

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ)¹ , Rockville, MD (Contract No. 290-02-0024).

Suggested citation:

Helfand M, Carson S. Screening for Lipid Disorders in Adults: Selective Update of 2001 U.S. Preventive Services Task Force Review. Evidence Synthesis No. 49. Rockville, MD: Agency for Healthcare Research and Quality, April 2008. AHRQ Publication no. 08-05114-EF-1. Available at http://www.ahrq.gov/downloads/pub/prevent/pdfser/lipides.pdf

The investigators involved have declared no conflicts of interest with objectively conducting this research.

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

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