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Evidence-Based Medicine

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Studies point the way to cholesterol screening recommendations for women

As women age, their risk of coronary heart disease (CHD) increases. Women currently account for half of all CHD deaths in the United States, and many studies have reported an association between CHD and high levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), the so-called bad cholesterol. Questions persist about the best cholesterol screening strategy for women to detect high cholesterol that can lead to CHD.

After reviewing recent studies on the impact of cholesterol screening in women on cholesterol reduction and CHD, David Atkins, M.D., M.P.H., and his colleagues discuss recommendations from national organizations and findings from recent large treatment trials on cholesterol screening in women. Dr. Atkins is Coordinator for Clinical Preventive Services at the Center for Practice and Technology Assessment, Agency for Healthcare Research and Quality.

The researchers note that periodically measuring TC and HDL-C in all middle-aged women and in younger women with diabetes or other major risk factors will detect most women with sufficiently high cholesterol to warrant statin drug therapy or intensive lifestyle interventions. For the remainder of average-risk younger women, more concerted efforts to promote smoking cessation, regular physical activity, healthy weight, and diets low in saturated fat and high in fruits and vegetables are probably more important than lipid screening.

The National Cholesterol Education Program guidelines recommend measuring nonfasting TC and HDL-C every 5 years in women beginning at age 20. The U.S. Preventive Services Task Force and American College of Physicians recommend beginning routine cholesterol screening of average-risk women at age 45, and perhaps earlier screening for high-risk women (those with multiple risk factors, diabetes, strong family history). All organizations recommend advising all patients to reduce dietary saturated fat, maintain a healthy weight, and increase physical activity. The benefits of lipid reduction for women who have both high LDL-C and high HDL-C (the so-called good cholesterol) remains an important but unsettled question.

For more details, see "Lipid screening in women," by Dr. Atkins, Judith M. Walsh, M.D., M.P.H., Michael Pignone, M.D., M.P.H., and Christopher J. Phillips, M.D., M.P.H., in the Summer 2000 Journal of the American Medical Women's Association 55(4), pp. 234-240.

Reprints (AHRQ Publication No. 00-R043) are available from the AHRQ Publications Clearinghouse.

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