America's cardiovascular establishment has strongly supported the National Cholesterol Education Program (NCEP) and its clinical guidelines for detection and management of dyslipidemias.1 In this issue of JAMA, Hulley et al2 trenchantly criticize the NCEP guidelines for young adults—men under 35 years of age and premenopausal women. They conclude that routine testing of all such persons every 5 years is of unproven effectiveness for prolonging life, very inefficient from an economic and clinical standpoint, and perhaps unethical given that primary preventive maneuvers alter the lives of otherwise well persons.
See also p 1416.
Underpinning their criticisms is a simple observation. In isolation, an elevated total cholesterol (TC) or low-density lipoprotein cholesterol (LDL) level is a mediocre marker for short-term and even longer-term risk of coronary events.3,4 This is especially so for young men and premenopausal women where coronary heart disease (CHD) is a rare cause of death. There
Naylor CD. Cholesterol Testing in Young AdultsPrudent or Profligate?. JAMA. 1993;269(11):1426–1427. doi:10.1001/jama.1993.03500110094044
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