Deciding who should be screened and treated for elevated cholesterol levels has profound implications for the health of our nation. Depending on the selection criterion for screening, the costs of screening and treatment and the potential savings by preventing myocardial infarction and death from coronary heart disease (CHD) can be staggering. The two extreme positions regarding the appropriate population to be screened and treated are those of the National Cholesterol Education Program (NCEP)1 and of Hulley and his associates.2 The NCEP recommends that all Americans aged 20 years and older be screened for high cholesterol and has prepared dietary and drug therapy guidelines for patients, millions of whom do not have clinical evidence of CHD. Since CHD is a progressive disease that may take decades to become manifest, the NCEP recommends primary as well as secondary prevention.
See also p 55.
Hulley and coworkers have reported that screening