Costs and health consequences of cholesterol screening for asymptomatic older Americans

Article Abstract:

Coronary heart disease is a major cause of death in this country. Some of the risk factors for coronary disease which can be modified include smoking, hypertension, and obesity. Recent developments have made a high blood level of cholesterol, or hypercholesterolemia, one of the modifiable risk factors. Measuring blood cholesterol is easy and inexpensive, medications to lower cholesterol are available and effective, and studies have shown that reduction of blood cholesterol levels, at least in middle-aged men, will indeed reduce the risk of heart disease. What effect treating high blood cholesterol levels in elderly patients will have on overall mortality from heart disease is unknown. Few studies have addressed the effectiveness of treating high cholesterol levels in the elderly, and several studies have even suggested that the elderly have a lower overall mortality with higher cholesterol levels. If studies that are currently underway show that treating high cholesterol levels in the elderly will reduce death from coronary heart disease, attention must be paid to the potential adverse effects of treatment. Dietary treatment is assumed to have no costs and no dangers, but those elderly patients who require drug therapy to lower their cholesterol levels may have risks. The drugs are certainly expensive, and they may interact unfavorably with other drugs the patient is taking. Until further information is available on the effectiveness of treating high cholesterol levels in the elderly, physicians should exercise caution in prescribing cholesterol-lowering drugs for them. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Aged, Elderly, Testing, Demographic aspects, Cholesterol, Hypercholesterolemia

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Screening for hypertension

Article Abstract:

If medical screening is to reduce the incidence and severity of disease as well as mortality, certain conditions must apply. The disease should be a common cause of morbidity and death, be detectable at a stage when it is without symptoms, and be treatable. Treatment at this early, presymptomatic stage should be available and more beneficial than delaying therapy until symptoms of the disease develop. In addition, the screening program must be cost-effective when compared with other health care interventions. The significance of hypertension, or high blood pressure, as a health problem, its early detection and effective treatment, and the benefits and costs of hypertension screening were evaluated. Review of studies on hypertension indicate that this disease is a major health problem that can be detected early and effectively treated. Screening of adults without symptoms of hypertension is most beneficial and cost-effective for older persons compared with younger persons, and for men compared with women. In addition, screening is highly sensitive to the cost of therapy for mild hypertension. Hypertension screening is recommended for all adults, and the frequency and setting of screening activities is discussed. The cost-effectiveness of hypertension screening is greater than other cardiovascular or circulation-related interventions when low-cost therapy is used. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Diagnosis

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A practice guideline revisited: screening for hypertension

Article Abstract:

Routine blood pressure tests continue to be a cost effective and valuable diagnostic tool. A researcher surveyed the literature published since 1989 to determine whether blood pressure testing guidelines needed to be updated. A 1990 survey on the cost-effectiveness of high blood pressure screening and treatment was also updated. No new studies have been done to alter the recommendation that patients should be routinely screened for high blood pressure. Performing a routine blood pressure test on otherwise healthy adults adds approximately 3 weeks to their life expectancy. With the rising cost of blood pressure medication, diuretics and beta-blockers may still be the most cost-effective medication when treatment is necessary.

Evaluation, Prevention, Practice guidelines (Medicine)

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