LETTER
American College of Physicians Guidelines on Cholesterol Screening
Mark R. Goldstein, MD
15 December 1996 | Volume 125 Issue 12 | Page 1007
TO THE EDITOR:
The 1 March 1996 issue included three papers on cholesterol screening that totaled 21 pages [1-3]. It is obvious that the topic is controversial and will continue to stimulate debate. However, cholesterol screening is not the real issue.
In these days of managed care and automated laboratory testing, we rarely have a choice about whether to screen patients for cholesterol levels. Some automated biochemical profiles may contain values for 25 items, including not only total cholesterol levels but levels of high-density lipoprotein cholesterol, triglycerides, and low-density lipoprotein cholesterol. We get these values whether we want them or not, in the young and old, in women and men. Given the way in which automated profiles are structured, it costs more not to get these already-included items.
Therefore, the real issue in 1996 is not whether to screen for cholesterol levels but what to do with the values that we inevitably receive. This is not a new concept. Just think of all the superfluous data physicians review. How valuable is the routine lactate dehydrogenase level? What about chloride levels? Do we need iron levels for everybody? How useful is knowledge of the globulin level of a healthy, middle-aged person?
Perhaps the 1 974 000 pages disseminated by Annals on cholesterol screening (21 pages x 94 000 subscribers) would have been better used if they had contained information on what we should do with the cholesterol levels we receive.
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Author and Article Information
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Crozer-Chester Medical Center, Upland, PA 19013.
1. American College of Physicians. Guidelines for using serum cholesterol, high-density lipoprotein cholesterol, and triglyceride levels as screening tests for preventing coronary heart disease in adults. Ann Intern Med. 1996; 124:515-7.
2. Garber AM, Browner WS, Hulley SB. Cholesterol screening in asymptomatic adults, revisited. Ann Intern Med. 1996; 124:518-31.
3. LaRosa JC. Cholesterol agonistics. Ann Intern Med. 1996; 124:505-8.
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