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Helfand M, Carson S. Screening for Lipid Disorders in Adults: Selective Update of 2001 US Preventive Services Task Force Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Jun. (Evidence Syntheses, No. 49.)

4Limitations and Conclusions

In this selective update, we reviewed new evidence available since the publication of the USPSTF 2001 recommendations on screening for lipid disorders in adults. 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. These other reports provide more detailed and thorough analysis than can be provided here. The main findings of this update, focusing on discrepancies between the USPSTF recommendations and ATP III and summarized in Table 1, should be viewed in this context.

Little new evidence directly addresses the discrepancies between ATP-III and the 2001 USPSTF recommendations. No new evidence examined whether targeting young adults at high risk is more effective than recommending healthy lifestyle behaviors to all. Another discrepancy in the recommendations concerns whether to include triglycerides in an initial screening panel. Results of recent studies are consistent with previous evidence and suggest that, although triglyceride level is a strong univariate predictor of CHD events, its association with such events is reduced substantially by adjustment for other risk factors. We did not identify new evidence relevant to the appropriate interval to screen for hyperlipidemia. The use of risk factors to select patients for treatment was not addressed in the 2001 USPSTF recommendation. Evidence from epidemiologic studies as well as from good-quality randomized controlled trials supports the idea that patients who have “CHD risk equivalents” benefit from lipid-lowering therapy similar to that used in individuals who have known CHD. New evidence demonstrates the efficacy of short-term primary prevention in high-risk individuals older than 65 and in high-risk individuals who have lower LDL-C levels than those enrolled in older trials. There is also strong evidence that lipid-lowering therapy is effective in women with coronary disease or diabetes, but there is still insufficient evidence from primary prevention trials to determine the effectiveness of lipid-lowering therapy in other low-risk and some intermediate risk groups under-represented in older trials. New evidence about harms of statin therapy comes from recent randomized controlled trials and FDA data analyses. The balance of benefits and harms is clearly in favor of statin therapy among individuals enrolled in some, but not all, randomized trials of short-term primary prevention. However, the applicability of these findings to individuals at higher risk of adverse events is unclear, and the long-term (>10 years) safety of statins is unknown.

Cover of Screening for Lipid Disorders in Adults: Selective Update of 2001 US Preventive Services Task Force Review
Screening for Lipid Disorders in Adults: Selective Update of 2001 US Preventive Services Task Force Review [Internet].
Evidence Syntheses, No. 49.
Helfand M, Carson S.


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