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American College of Physicians Guidelines on Cholesterol Screening
- Alan M. Garber, MD, PhD;
- Warren S. Browner, MD, MPH; and
- Stephen B. Hulley, MD, MPH
- Stanford University School of Medicine, Veterans Affairs Palo Alto Health Care System, Stanford, CA 94305. University of California, San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94143.
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IN RESPONSE:
As Dr. Fronduti surmises, the statement that screening is not recommended for persons 75 years of age and older applies only to primary prevention. The recommendation to do lipid analysis in all persons with known coronary heart disease or other vascular disease applies to men and women of all ages.
In many practice settings, as Dr. Goldstein observes, the key issue is what to do with knowledge of a cholesterol level that may have been obtained incidentally as part of a blood chemistry panel. Recognizing that incidental abnormalities discovered in this way may be falsely positive or otherwise unhelpful, many institutions (including our own) no longer report the results of dozens of tests when the physician had only intended to order one or a few. Until this practice is more widespread, we suggest interpreting the cholesterol level by using the information given in the background paper [1], especially Tables 3 …
