Cholesterol Journal Articles

Record 2861 to 2880

Cholesterol screening as a component of pediatric preventive cardiology. The office setting in hyperlipidemia in children
Strong, W. B. (1991), Ann N Y Acad Sci 623: 214-21.

Cholesterol screening by primary care pediatricians: a study of attitudes and practices in the Minneapolis-St Paul metropolitan area
Arneson, T., R. Luepker, et al. (1992), Pediatrics 89(3): 502-5.
Abstract: A telephone survey of the 197 board-certified pediatricians actively engaged in primary care in the Minneapolis-St Paul metropolitan area was conducted to assess their cholesterol screening practices and hypercholesterolemia management. The response rate was 95%. Nearly all the pediatricians (90%) do some cholesterol screening, with the majority (58%) screening only children with a strong family history of coronary heart disease. Though only 33% screen all their patients, 66% advocate universal pediatric screening. Most of the pediatricians indicated they would manage hypercholesterolemia patients themselves, nearly always with dietary means. Despite their strong support for screening, the pediatricians expressed skepticism about the significance of childhood cholesterol level as a predictor of adult cardiovascular disease and doubted their effectiveness in getting patients to adopt a cholesterol-reducing diet. Their definition of elevated total cholesterol level in childhood was consistent with published recommendations, but only 29% could define elevated low-density lipoprotein cholesterol level. The pediatricians expressed strong opposition to pediatric cholesterol screening in schools or in any setting other than clinics and hospitals.

Cholesterol screening for blood donors: characteristics of screenees and determinants of follow-up behavior
Nichol, K. L., M. M. Azar, et al. (1993), Am J Prev Med 9(4): 231-6.
Abstract: This study assesses the ability of a blood donor cholesterol screening program to enhance awareness of cholesterol levels among screenees and to promote lifestyle changes and physician follow-up. Beginning in November 1990, all blood donors at the Minneapolis Veterans Affairs Medical Center were offered free cholesterol screening. Each screenee also received educational materials and brief counseling from a nurse. Two weeks after donation, screenees received a postcard with their cholesterol level and information regarding recommended follow-up. Baseline information for all screenees was obtained at the time of donation through a self-administered questionnaire. Follow-up data were collected through structured telephone interviews. During the program's first four months, 1,039 donors (33%) requested cholesterol screening. At baseline, 82.6% of screenees had at least one risk factor for coronary heart disease, and 37% had two or more risk factors. More than one third were unaware of their cholesterol levels. At follow-up, more than 95% indicated that they were aware of their cholesterol levels, and 90% of those with high cholesterol levels had followed up with their physician or made dietary or other lifestyle changes. We conclude that a cholesterol screening and minimal intervention program for blood donors enhances awareness of cholesterol levels and encourages dietary or other lifestyle changes.

Cholesterol screening guidelines consensus, evidence, and the departure from common sense
LaRosa, J. C. and T. A. Pearson (1997), Circulation 95(6): 1651-3.

Cholesterol screening guidelines. Consensus, evidence, and common sense
Garber, A. M. and W. S. Browner (1997), Circulation 95(6): 1642-5.

Cholesterol screening in 5,719 self-referred elderly subjects
Fritzsche, V., T. Tracy, et al. (1990), J Gerontol 45(6): M198-202.
Abstract: To assess the frequency of hypercholesterolemia as a potential major public health problem in the elderly, we studied 5,719 self-referred subjects greater than age 60 and 11,890 less than or equal to 60 years, whose nonfasting capillary blood cholesterol levels were measured during an 18-month screening in Cincinnati area grocery stores. We followed National Cholesterol Education Program guidelines for serum cholesterol (less than 200 mg/dl "desirable," 200-239 "borderline-high," and greater than or equal to 240 mg/dl "high"). Of 4,011 61-70 year-olds, only 19% had capillary blood total cholesterol less than 200, 38% were 200-239, and 43% greater than or equal to 240 mg/dl. Of 1,493 aged 71-80 years, only 20% had total cholesterol less than 200, 36% had levels 200-239, and 44% were greater than or equal to 240 mg/dl. In 215 subjects, 81 and over, 29% had total cholesterol less than 200, 36% were 200-239, and 35% were greater than or equal to 240 mg/dl. Application of the non-age, non-race, non-sex specific National Cholesterol Education Program guidelines to the elderly may necessitate followup and perhaps therapy in 71-81% of subjects, suggesting that the appropriate intervention approach be general population-oriented, rather than the individual detection, diagnosis, and treatment approach which presents a huge, expensive load for a relatively unprepared health care community.

Cholesterol screening in a black inner-city pediatric population
Woerner, E. M. and M. L. Schaaf (1991), South Med J 84(2): 179-85.
Abstract: A screening for total blood cholesterol levels was conducted by the University of Louisville Department of Family Practice in association with the National Youth Sports Program in Louisville, Kentucky. On May 30, 1987, 224 inner-city children between 10 and 16 years of age were tested; 109 (49%) were girls and 115 (51%) were boys. All participants were black. Of the entire population, the girls had a slightly lower mean level of cholesterol than the boys (160 mg/dL vs 165 mg/dL, respectively). Because of the large number of participants aged 10 to 14 years (211), this subset of children was studied more closely. In this age group, 47 (22%) of the children were at moderate risk for future cardiovascular disease and 48 (23%) were at high risk. The serum cholesterol levels were relatively constant in all children until age 12, after which a slight reduction occurred. This decrease is more evident in boys. Our study also showed a correlation between increased blood cholesterol and above normal weight/height indices (ie, Quetelet scores), with nearly 70% of all children having elevated cholesterol levels also exhibiting above normal Quetelet scores. We observed no correlation between high cholesterol levels and high blood pressure in this study population. Dietary intervention is recommended as the initial treatment for elevated cholesterol levels in children.

Cholesterol screening in a community health promotion program: epidemiologic results from a biracial population
Muscat, J. E., C. Axelrad, et al. (1994), Public Health Rep 109(1): 93-8.
Abstract: The prevalence and interrelationship of high blood cholesterol levels with other cardiovascular disease risk factors were studied in a biracial suburb of New York City. Participants in community-based screenings to determine blood cholesterol levels have been predominantly white women in older age groups, highly educated and nonsmokers. To reach a more representative segment of a local population and promote healthy lifestyle behaviors, cholesterol screenings were conducted within an ongoing health promotion program in Mount Vernon, NY. Plasma cholesterol levels were determined for 5,011 participants, including 2,308 whites and 1,778 blacks. Of the men, 29 percent had high cholesterol levels; among women, it was 27 percent. Of the men with high levels, half had levels greater than 200 milligrams per deciliter, as did 55 percent of the women. After statistical adjustments were made for age and other risk factors for high blood cholesterol, mean cholesterol levels were higher for whites than blacks. The level for white men was 204 milligrams per deciliter; for women, 212. For black men, the level was 199 milligrams per deciliter; for women, 208, P <.10. Hispanic men had levels of 199, P <.10. The levels for Hispanic women (203 milligrams per deciliter) were significantly lower than that of white women. Among whites who smoked more than 1 pack of cigarettes per day, mean cholesterol levels were 11 milligrams per deciliter higher than for those who never smoked or were light smokers (0, 1-20 cigarettes per day, P <.10). There were too few who smoked more than 1 pack to test this association adequately among blacks.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesterol screening in a community pharmacy
Madejski, R. M. and T. J. Madejski (1996), J Am Pharm Assoc (Wash) NS36(4): 243-8.
Abstract: The authors conducted a pilot study to identify patients at risk for developing cardiovascular disease and to see if the community pharmacy is an appropriate site for identifying patients with hypercholesterolemia. Free cholesterol screenings were advertised in newspapers and in the pharmacy. Patients obtained an appointment time for the screening by calling an 800 number and were interviewed for risk factors associated with coronary heart disease. Of the 539 patients enrolled in the study, 78% of patients had abnormal cholesterol levels. Approximately 85% of the abnormal group were contacted again. Eighty-three percent of patients reported lifestyle modifications. Eighty-one percent of patients with elevated cholesterol levels requested diet information, and 23% accepted the offer to rescreen. We conclude that the community pharmacy is an easily accessible, well accepted, and effective site for cholesterol screenings; pharmacist interventions may help patients reduce their risk of coronary heart disease; and the pharmacy may benefit financially from an increase in dispensing lipid-lowering medications.

Cholesterol screening in a healthy father of 4 children--an ethical dilemma for the district physician
Karlberg, L. (1990), Lakartidningen 87(35): 2688-90.

Cholesterol screening in a pediatric population at atherosclerotic risk
Spinello, M., C. Montanari, et al. (1991), Pediatr Med Chir 13(6): 583-4.
Abstract: We studied 344 children (174 girls and 170 boys) between the ages of 6 and 15 years (average age 11 years 9 months) chosen on the basis of a positive family anamnesis for dismetabolic and/or precocious cardiovascular pathologies, and also on the basis of objective data obtained at medical examinations, such as obesity and hypertension. These subjects underwent blood tests for glycaemia, total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Children with total cholesterol levels above 170 mg/dl were considered to be hypercholesterolemic. 127 young people (65 girls and 62 boys) turned out to have excessively high cholesterol levels with an average level of 195.71 +/- 23.11 mg/dl and average LDL level of 127.05 +/- 25.08 mg/dl. 217 subjects (109 girls and 108 boys) turned out to be within the norm with total cholesterol level of 137.76 +/- 23.04 mg/dl and LDL cholesterol 75.59 +/- 22.89 mg/dl. We found a greater difference between the average values of LDL cholesterol and those of total cholesterol (40.5% compared to 29.61%), which shows that even at pediatric ages the LDL cholesterol concentration is the factor which best indicates the risk level for atherosclerotic development.

Cholesterol screening in an ED-based chest pain unit
Diercks, D. B., J. D. Kirk, et al. (2002), Am J Emerg Med 20(6): 510-2.
Abstract: To evaluate the prevalence of dyslipidemia in patients who are evaluated in a chest pain evaluation unit (CPEU) a prospective study of all patients admitted to our CPEU from January 1 to December 31, 1999 was conducted. Serum total cholesterol (TC) and high density lipoprotein (HDL) levels were obtained unless prior levels were known or at the discretion of the attending physician. Both TC and HDL were tested in 606 (59%) patients. Abnormal lipid levels were reported in 306 (50%) patients. Of these, 86 had both abnormal TC and HDL. Isolated low HDL levels were found in 60 of the patients and TC alone was abnormal in 160. Of the 246 patients with abnormal TC, 169 (69%) had borderline high levels (200-239 mg/dL) and 77 (31%) had high levels (>or=240 mg/dL). Our study shows a high prevalence of abnormal lipid levels in patients, as identified by a screening protocol in our CPEU.

Cholesterol screening in asymptomatic adults, revisited. Part 2
Garber, A. M., W. S. Browner, et al. (1996), Ann Intern Med 124(5): 518-31.
Abstract: OBJECTIVE: To assess the role of serum lipid levels as screening tests in adults. DESIGN: Pooled analysis of clinical trials, supplemented by analysis of data from the Framingham Heart Study, to estimate the effect of cholesterol reduction in patient groups stratified by cardiac risk. STUDY SELECTION: Published randomized controlled trials of cholesterol reduction, meta-analyses of such trials, prospective cohort studies of the association between cholesterol levels and morbidity and death related to coronary heart disease, and cost-effectiveness analyses of cholesterol reduction. DATA ANALYSIS: Two-stage logistic regression on cardiac risk factors and outcomes in the Framingham Heart Study. The first stage predicted the risk for death from coronary heart disease using standard risk factors but not cholesterol; the second stage predicted the risk for death from coronary heart disease and all causes as functions of age and cholesterol level, stratified by the risk predicted from the first stage. RESULTS: Randomized clinical trials show that cholesterol reduction confers survival benefits in patients with symptomatic coronary disease. In asymptomatic middle-aged men, who are at lower risk for death from coronary disease, cholesterol reduction prevents coronary disease but has not been shown to prolong life. The risk model based on analysis of the data from the Framingham Heart Study is consistent with the randomized trial data and shows that in the demographic groups excluded from trials, the hypothetical benefits of cholesterol reduction are greatest when the underlying risk for coronary disease is greatest. CONCLUSIONS: Screening with total cholesterol levels is most likely to be useful when done in populations at high short-term risk for dying of coronary heart disease, such as survivors of myocardial infarction and middle-aged men with multiple cardiac risk factors. In these populations, cholesterol reduction appears to be both effective and cost-effective. In other populations, the benefits of reduction are much smaller or are uncertain.

Cholesterol screening in childhood
Orchard, T. J., A. L. Drash, et al. (1992), Ann Epidemiol 2(5): 763-7.

Cholesterol screening in childhood. Targeted versus universal approaches
Kuehl, K. S. (1991), Ann N Y Acad Sci 623: 193-9.

Cholesterol screening in childhood: results of a 9-year follow-up study in Swiss and Italian children in Switzerland
Mohler, B., U. Ackermann-Liebrich, et al. (1996), Soz Praventivmed 41(6): 333-40.
Abstract: Mass screening for blood cholesterol as part of routine preventive health care of children continues to be discussed in several countries. Results of longitudinal studies underline the importance of the predictive value of cholesterol levels assessed during childhood. Some countries have changed their recommendations during the past years to blood cholesterol screening for obese children only or for children of high risk families. In the Kindergarten-study Basel, a follow-up study on somatic, psychic and social development of Swiss and immigrant schoolchildren, cardiovascular risk factors were assessed at the ages of 5, 10 and 14 years. The age-specific levels of total and LDL-cholesterol found in our study were slightly higher and HDL-cholesterol lower than, for example, those found in the Bogalusa Heart Study. For total cholesterol no significant tracking correlations over the 5 and 9 year periods were found. Tracking of LDL- and HDL-cholesterol differed between nationalities and sexes. The total cholesterol/HDL-cholesterol index tracked slightly better. Italian girls showed the best 9-year tracking for HDL-cholesterol (r = 0.56). The differences between this and other studies can only partially be explained by different sampling and laboratory methods. Individual changes in cholesterol levels between the ages of 5 and 14 were marked. Sexual maturation was found to be of minor influence. Body mass index was the most consistent risk factor in our population. Changes of sex or growth hormone levels during puberty, but also changes of nutritional habits or physical activity might influence the individual cholesterol levels. Before recommendations on mass screening of cholesterol in children are made, the different longitudinal patterns of changes in cholesterol levels, and subpopulation-specific changes of nutritional habits and physical activity, should be discussed. The results of the Kindergarten study Basel suggest that attention should be paid to screening for obesity and to health education regarding nutrition and physical activity.

Cholesterol screening in childhood: sixteen-year Beaver County Lipid Study experience
Stuhldreher, W. L., T. J. Orchard, et al. (1991), J Pediatr 119(4): 551-6.
Abstract: To determine the extent to which cholesterol measured in childhood is predictive of values in adulthood, the investigators conducting the second follow-up of the Beaver County Lipid Study tracked the cholesterol values of 295 adults who had initially participated as children (ages 11 to 14 years) in a countywide school screening program. The follow-up study was conducted 16 years after the initial study, when the participants had reached a mean age of 28 years. The overall correlation (r) between baseline (1972-1973) total cholesterol values and the values found at the present follow-up was 0.44 (p less than 0.0001). Women had a higher correlation (r = 0.51) than men (r = 0.38). In addition, the efficacy of childhood screening for cholesterol levels was assessed by considering currently recommended borderline values (greater than 175 mg/dl (4.6 mmol/L) for children and greater than 200 mg/dl (5.2 mmol/L) for adults) as a "positive" test result. The sensitivity of screening at age 12 years for predicting elevated adult total cholesterol concentrations was 63%, specificity was 67%, and the predictive value of a positive test result was 47%. Comparison of false-positive results (above the borderline cutoff point as a child but not as an adult) and false-negative results (below the borderline cutoff point as a child but above it as an adult) showed that male subjects with false-positive results smoked significantly less than those with false-negative results (p less than 0.05) and had a greater improvement during the preceding 7 years in cholesterol-lowering dietary practices (p less than 0.01). Female subjects with false-positive results smoked significantly less than those with false-negative results (p less than 0.05), were less overweight (p less than 0.05), and had a lower prevalence of oral contraceptive use (p less than 0.01). These results support the potential value of screening for hypercholesterolemia in childhood on a population basis. Although some subjects were misclassified as a result of childhood screening, some of this misclassification was associated with adopting changes that a screening and intervention program would be designed to promote--nonsmoking, weight control, and a prudent diet.

Cholesterol screening in children and adolescents
Newman, T. B. and A. M. Garber (2000), Pediatrics 105(3 Pt 1): 637-8.

Cholesterol screening in children during office visits
Davidson, D. M., R. M. Smith, et al. (1990), J Pediatr Health Care 4(1): 11-7.
Abstract: Elevated blood cholesterol levels, a major risk for coronary artery disease in adults, has been associated with atherosclerotic disease in children. More than 10% of North American children have blood cholesterol levels higher than the desirable levels for adults. Current guidelines recommend screening only in children who have a family history of hyperlipidemia or myocardial infarction at an early age; however, this method fails to identify most children with hypercholesterolemia. Office-based cholesterol screening is an effective means to identify children and family members for dietary assessment and counseling. Should these measures be insufficient to lower the child's cholesterol level, referral for pharmacologic treatment is indicated.

Cholesterol screening in children. State of the art
Haley, N. J., P. Cronin, et al. (1991), Ann N Y Acad Sci 623: 155-64.

Cholesterol Articles and Abstracts

Cholesterol Journal Articles