Cholesterol Screening
You may have heard an opinion that doctors should stop testing or screening their patients for cholesterol.
Why after all these years of talking about and studying cholesterol are doctors still arguing about who should have their cholesterol measured? Let's briefly go into the history behind this "controversy.
" Conventional medical wisdom - based upon many different studies from all over the world conducted over the last several decades - is that high cholesterol levels are very strongly associated with risk of heart disease.
Based upon this circumstantial evidence alone, however, we can not say for sure that lowering cholesterol will decrease the risk of heart disease.
But, thanks to other studies specifically designed to measure effects of lowering cholesterol, we can now say definitively that lowering cholesterol does indeed decrease the risk of heart attack.
This is especially true in people who have had one heart attack already; in fact, most doctors agree that people with heart disease should be treated to lower their cholesterol, cholesterol screening.
The controversy about cholesterol screening has centered around the issue of using medication to lower cholesterol in people who don't already have known heart disease.
This is known as "primary prevention" because its purpose is to prevent that first heart attack.
Until recently, the clinical information concerning this topic was incomplete: lowering cholesterol decreased heart attacks but not deaths from all causes and therefore its value in this setting was not completely established.
However, a recent study using pravachol, one of the "statin" drugs (a class of drugs that powerfully and safely lower cholesterol ) demonstrated that both heart attacks and deaths from all causes were substantially less in persons who took the medication for five years.
Therefore, it seems clear that if you are at high risk of developing heart disease and have an elevated cholesterol level that you can't control with diet, you will probably benefit from treatment to lower your cholesterol.
The recommendations about when to use medication to lower cholesterol were issued by an expert panel from the National Institutes of Health and have been endorsed by virtually all the major medical organizations, including the American Heart Association, cholesterol screening.
So where is the controversy? The controversy started when a group of physicians associated with an organization called the American College of Physicians issued guidelines recommending that cholesterol screening not be done on healthy people.
The concern was that many doctors use drugs to lower cholesterol in people who shouldn't receive drug treatment.
If anything, available information suggests that doctors are still not recommending cholesterol medication enough, even for patients with established heart disease.
In any case, these physicians developed their own guidelines, which recommended that physicians stop screening for cholesterol levels in healthy men under 35 and women under 45, as well as in all "older" people over 65.
There are several problems with this recommendation.
First, there are things you can do short of taking medication to lower your cholesterol and decrease your risk of heart disease, but only if you know you have a problem.
For example, if you know that you have high cholesterol, you might be more inspired to eat better, exercise more, and lose weight.
Second, the process that causes heart disease starts well before age 35, in fact, it starts in the teen years.
Why wait until it has already established itself, then try to reverse the process? Finally, there are clearly people with very high cholesterol levels who do need medication but who would never know that they had a high cholesterol unless they had been screened.
Many experts have commented on the curious fact that these recommendations came at a time when the evidence linking cholesterol- lowering with decreased heart disease risk is coming faster than ever.
In fact, most major professional organizations, including the National Institutes of Health and the American Heart Association, have denounced these recommendations, cholesterol screening research.
The bottom line: experts agree that having your cholesterol measured is one of the cheapest, most reliable ways to determine your risk of heart disease and can point you toward concrete ways to decrease that risk.
Don't be confused by the "controversy;" regardless of your age, you are potentially at risk for heart disease and knowing your cholesterol level can help.
Why after all these years of talking about and studying cholesterol are doctors still arguing about who should have their cholesterol measured? Let's briefly go into the history behind this "controversy.
" Conventional medical wisdom - based upon many different studies from all over the world conducted over the last several decades - is that high cholesterol levels are very strongly associated with risk of heart disease.
Based upon this circumstantial evidence alone, however, we can not say for sure that lowering cholesterol will decrease the risk of heart disease.
But, thanks to other studies specifically designed to measure effects of lowering cholesterol, we can now say definitively that lowering cholesterol does indeed decrease the risk of heart attack.
This is especially true in people who have had one heart attack already; in fact, most doctors agree that people with heart disease should be treated to lower their cholesterol, cholesterol screening.
The controversy about cholesterol screening has centered around the issue of using medication to lower cholesterol in people who don't already have known heart disease.
This is known as "primary prevention" because its purpose is to prevent that first heart attack.
Until recently, the clinical information concerning this topic was incomplete: lowering cholesterol decreased heart attacks but not deaths from all causes and therefore its value in this setting was not completely established.
However, a recent study using pravachol, one of the "statin" drugs (a class of drugs that powerfully and safely lower cholesterol ) demonstrated that both heart attacks and deaths from all causes were substantially less in persons who took the medication for five years.
Therefore, it seems clear that if you are at high risk of developing heart disease and have an elevated cholesterol level that you can't control with diet, you will probably benefit from treatment to lower your cholesterol.
The recommendations about when to use medication to lower cholesterol were issued by an expert panel from the National Institutes of Health and have been endorsed by virtually all the major medical organizations, including the American Heart Association, cholesterol screening.
So where is the controversy? The controversy started when a group of physicians associated with an organization called the American College of Physicians issued guidelines recommending that cholesterol screening not be done on healthy people.
The concern was that many doctors use drugs to lower cholesterol in people who shouldn't receive drug treatment.
If anything, available information suggests that doctors are still not recommending cholesterol medication enough, even for patients with established heart disease.
In any case, these physicians developed their own guidelines, which recommended that physicians stop screening for cholesterol levels in healthy men under 35 and women under 45, as well as in all "older" people over 65.
There are several problems with this recommendation.
First, there are things you can do short of taking medication to lower your cholesterol and decrease your risk of heart disease, but only if you know you have a problem.
For example, if you know that you have high cholesterol, you might be more inspired to eat better, exercise more, and lose weight.
Second, the process that causes heart disease starts well before age 35, in fact, it starts in the teen years.
Why wait until it has already established itself, then try to reverse the process? Finally, there are clearly people with very high cholesterol levels who do need medication but who would never know that they had a high cholesterol unless they had been screened.
Many experts have commented on the curious fact that these recommendations came at a time when the evidence linking cholesterol- lowering with decreased heart disease risk is coming faster than ever.
In fact, most major professional organizations, including the National Institutes of Health and the American Heart Association, have denounced these recommendations, cholesterol screening research.
The bottom line: experts agree that having your cholesterol measured is one of the cheapest, most reliable ways to determine your risk of heart disease and can point you toward concrete ways to decrease that risk.
Don't be confused by the "controversy;" regardless of your age, you are potentially at risk for heart disease and knowing your cholesterol level can help.
