Comparison of methods to identify individuals at increased risk of
coronary disease from the general population |
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| Authors: | S Wilson A Johnston J Robson N Poulter D Collier G Feder M J Caulfield |
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| Institution: | 1 Clinical Pharmacology, William Harvey Research Institute, Barts and The London, Queen Mary''s School of Medicine and Dentistry, London EC1M 6BQ;2 General Practice and Primary Care, Institute of Community Health Sciences, Barts and The London, Queen Mary''s School of Medicine and Dentistry, London E1 4NS;3 Cardiovascular Studies Unit, Clinical Pharmacology and Therapeutics, Imperial College London, St Mary''s Campus, London W2 1PG |
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| Abstract: | Objectives To evaluate the guidelines on measurement of cholesterol
in the national service framework for coronary heart disease and to compare
alternative strategies for identifying people at high risk of coronary disease
in the general population.Design Comparison of methods (national service framework criteria,
Sheffield tables, age threshold of 50 years, estimated risk assessment using
fixed cholesterol values) for identifying people with a 10 year coronary event
risk of 15% or greater.Setting Health survey for England 1998.Subjects 6307 people aged between 30 and 74 years with no history of
myocardial infarction, stroke, or angina.Main outcome measures Proportion of the total population selected
for measurement of cholesterol and proportion of people at 15% or greater risk
identified.Results The national service framework guidelines selected 43.4%
(95% confidence interval 42.2% to 44.6%) of the study population for
cholesterol measurement and identified 81.2% (80.2% to 82.2%) of those at 15%
or greater risk. The Sheffield tables selected 73.1% (72.0% to 74.2%) for
cholesterol measurement and identified 99.91% (99.83% to 99.99%) of those at
15% or greater risk. An age threshold of 50 years selected 46.3% (45.1% to
47.5%) for cholesterol measurement and identified 92.8% (92.1% to 93.4%) of
those at 15% or greater risk. Estimated risk assessments using fixed
cholesterol values selected 17.8% (16.8% to 18.7%) for cholesterol measurement
and identified 75.9% (74.8% to 76.9%) of those at 15% or greater risk.Conclusion Measuring the cholesterol concentration of everyone aged
50 years and over is a simple and efficient method of identifying people at
high risk of coronary disease in the general population. |
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