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August 1990

Within-Person Fluctuations of Serum Cholesterol and Lipoproteins

Arch Intern Med. 1990;150(8):1645-1648. doi:10.1001/archinte.1990.00040031645011

The National Cholesterol Education Program has begun a National Campaign to screen millions of adult Americans for serum cholesterol. To determine whether such random samples represent an individual's true lipoprotein status, we measured fasting total serum cholesterol and lipoproteins, on a weekly basis for 4 weeks, in 20 subjects ages 22 to 63 years. Duplicate samples were tested by two standardized laboratories, each on five consecutive days. Variations of more than ±20% in the, serum levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were seen in 75%, 95%, and 65% of the subjects, respectively. On retesting, 40% of the subjects moved in or out of one "risk category"; and in 10%, two categories, from "desirable" to "high risk," or vice versa. These data demonstrate that random testing may fail to detect wide fluctuations in the levels of serum lipoproteins, and therefore result in erroneous risk assignment or therapeutic intervention.

(Arch Intern Med. 1990;150:1645-1648)

Neaton JD, Kuller LH, Wentworth D, Borhani NO.  Total and cardiovascular mortality in relation to cigarette smoking, serum cholesterol concentration and diastolic blood pressure among black and white males followed up for five years (MRFIT) .  Am Heart J. 1984;108:759-769.Crossref
Martin MJ, Hulley SB, Browner WS, Kuller LH, Wentworth D.  Serum cholesterol, blood pressure and mortality: implications from a cohort of 361 662 men .  Lancet. 1986;2:933-936.Crossref
Grundy SM, Greenland P, Herd A, et al.  Cardiovascular and risk factor evaluation of healthy American adults: American Heart Association Position Statement .  Circulation . 1987;75:1340A-62A.
Lipid Research Clinics Program.  The Lipid Research Clinics Coronary Primary Prevention Trial Results, II: the relationship of reduction in incidence of coronary heart disease to cholesterol lowering .  JAMA. 1984;251:365-374.Crossref
Consensus Development Conference.  Lowering blood cholesterol to prevent heart disease .  JAMA. 1985;253:2080-2086.Crossref
 treatment, changes in risk factors, and incidence of coronary heart disease .  N Engl J Med. 1987;317:1237-1245.FrickCrossref
National Heart, Lung, and Blood Institute.  Report of the National Cholesterol Education Program: expert panel on detection, evaluation and treatment of high blood cholesterol levels in adults .  Arch Intern Med. 1988;148:3639.Crossref
Blank DW, Hoeg JM, Kroll MH, Ruddel ME.  The method of determinition must be considered in interpreting blood cholesterol .  JAMA. 1986;256:2867-2870.Crossref
Naito NK, Hartmann AE.  The ABC's of Cholesterol Standardization . Skokie, Ill: College of American Pathologists; 1988.
Current Status of Blood Cholesterol Measurements in Clinical Laboratories in the United States.  A report from the Laboratory Standardization Panel of the National Cholesterol Education Program .  Clin Chem. 1988;34:193-201.
 Statistical Analysis System . Carey, NC: SAS Institute Inc; 1985.
Jacobs DR, Barrett-Connor E.  Retest reliability of plasma cholesterol and triglyercides: the Lipid Research Clinics Prevalence Study .  Am J Epidemiol. 1982;116:878-885.
Hegsted DM, Nicolosi RJ.  Individual variation in serum cholesterol levels .  Proc Natl Acad Sci USA. 1987;84:6259-6261.Crossref
Wynder El, Field F, Haley NJ.  Population screening for cholesterol determination: a pilot study .  JAMA. 1986;256:2839-2842.Crossref
Landzberg JS, Heim CR.  Physician recognition and treatment of hypercholesterolemia .  Arch Intern Med. 1989;149:933-935.Crossref
Tunstall-Pedoe H, Smith WC, Tavendale R.  How-often-that-high graphs of serum cholesterol: findings from the Scottish Heart Health and Scottish MONICA Studies .  Lancet. 1989;1:540-542.Crossref
The Lovastatin Study Group II.  Therapeutic response to lovastatin (Mevinolin) in nonfamilial hypercholesterolemia: a multi-center study .  JAMA. 1986;256:2829-2834.Crossref
Grundy SM, Goodman DS, Rifkind BM, CleemanJI.  The place of HDL in cholesterol management: a perspective from the National Cholesterol Education Program .  Arch Intern Med. 1989;149:505-510.Crossref