Measuring and knowing: the trouble with cholesterol and decision making

Article Abstract:

It is well accepted that lowering low-density lipoprotein (LDL) cholesterol prevents heart attacks. Attention is now focused on developing and using techniques for lowering LDL cholesterol levels. Several approaches are being taken in US treatment guidelines and the accuracy of laboratory cholesterol measurements is being improved. Recommendations have been made to identify and treat high-risk individuals, and to reduce cholesterol levels for the entire population. As part of the approach toward identifying high-risk patients, reasonable but arbitrary cut-off points have been made. Due to variability in cholesterol measurements, it is suggested that treatment decisions be based on the results of two or three blood tests. There remains a chance for inaccurate patient classification and treatment if decisions are based on one blood cholesterol measurement. Miscalculations are more likely to occur for those people with cholesterol measurements close to the cut-off point. In the September 25, 1991 issue of The Journal of the American Medical Association, Irwig and associates address the issue of these miscalculations, and focus on helping physicians make clinical decisions based on accurate cholesterol blood levels. The editor notes that decisions regarding classification of a patient as having elevated cholesterol and in need of treatment for this condition must not be made solely on the basis of cholesterol measurement. Treatment decisions must be based on a patient's overall risk of developing disease as a result of elevated cholesterol. Identifying patients at risk for heart attack and preventing these attacks remains difficult. Although measurement of LDL cholesterol levels is not an exact indicator of risk and only provides an estimate of the true cholesterol level, lowering LDL cholesterol does reduce the incidence of heart attack. As often occurs in medicine, treatment decisions regarding elevated cholesterol must be based on incomplete information. (Consumer Summary produced by Reliance Medical Information, Inc.)

Planning, Diagnosis, Measurement, Risk factors, Heart attack, Blood cholesterol, Hypercholesterolemia, Medical protocols, editorial

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How to Use Guidelines and Recommendations About Screening

Article Abstract:

Tips are given to help doctors evaluate recommendations for screening patients for specific diseases. An example is colorectal cancer, which can be detected by the fecal occult blood test (FOBT). This test measures small amounts of blood in stool samples. However, it has a high false-positive rate, which would lead to unnecessary colonoscopy. Colonoscopy also has complications. Therefore, there must be evidence from clinical trials that screening saves lives. Doctors must also determine if the screening method is cost-effective. The patient's attitudes must also be considered.

Usage, Evaluation, Practice guidelines (Medicine), Medical screening, Health screening

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