Costs and health consequences of cholesterol screening for asymptomatic older Americans.

To predict the consequences of cholesterol screening among elderly Americans who do not have symptoms of heart disease, we explore the cost implications of a cholesterol screening program, evaluate evidence linking hypercholesterolemia to coronary heart disease and mortality in the elderly, and describe the likely effects of therapy of hypercholesterolemia. According to our calculations, if all Americans 65 years of age and older adhered to a cholesterol screening program similar to the one proposed by the National Cholesterol Education Program, minimum annual expenditures for screening and treatment would be between $1.6 billion and $16.8 billion, depending on the effectiveness of diet and the cost of the medications used to treat hypercholesterolemia. There is no direct evidence that this program would lessen overall morbidity or extend the lives of elderly Americans.

[1]  K. Matthews,et al.  Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. , 1990, BMJ.

[2]  S. Grundy,et al.  Hypercholesterolemia in elderly persons: resolving the treatment dilemma. , 1990, Annals of internal medicine.

[3]  T. Gross,et al.  Prescribed use of cholesterol-lowering drugs in the United States, 1978 through 1988. , 1990, JAMA.

[4]  D. Reed,et al.  Is elevated serum cholesterol level a risk factor for coronary heart disease in the elderly? , 1990, JAMA.

[5]  R. Vestal,et al.  Management of drug therapy in the elderly. , 1989, The New England journal of medicine.

[6]  J. Cleeman,et al.  The prevalence of high blood cholesterol levels among adults in the United States. , 1989, JAMA.

[7]  D. Gordon,et al.  Treating high blood cholesterol in the older patient. , 1989, The American journal of cardiology.

[8]  B. Forette,et al.  CHOLESTEROL AS RISK FACTOR FOR MORTALITY IN ELDERLY WOMEN , 1989, The Lancet.

[9]  C. Isles,et al.  Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley survey. , 1989, BMJ.

[10]  G. Rosenhamer,et al.  Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid. , 2009, Acta medica Scandinavica.

[11]  W. Kannel,et al.  Proportional Hazards Analysis of Risk Factors for Coronary Heart Disease in Individuals Aged 65 or Older , 1988, Journal of the American Geriatrics Society.

[12]  D. Malenka,et al.  Cholesterol and coronary heart disease. The importance of patient-specific attributable risk. , 1988, Archives of internal medicine.

[13]  K. O’malley,et al.  Prescribing for the Elderly: Part II Prescribing Patterns: Differences Due to Age , 1988, Journal of the American Geriatrics Society.

[14]  L. Nolan,et al.  Prescribing for the Elderly Part I: Sensitivity of the Elderly to Adverse Drug Reactions * , 1988, Journal of the American Geriatrics Society.

[15]  Daniel Steinberg,et al.  Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. The Expert Panel. , 1988, Archives of internal medicine.

[16]  A. Reunanen,et al.  Serum cholesterol and risk of cancer in a cohort of 39,000 men and women. , 1988, Journal of clinical epidemiology.

[17]  J. Huttunen,et al.  Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. , 1987, The New England journal of medicine.

[18]  R. Hoover,et al.  SERUM CHOLESTEROL AND CANCER IN THE NHANES I EPIDEMIOLOGICAL FOLLOW-UP STUDY , 1987, The Lancet.

[19]  D H Blankenhorn,et al.  Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. , 1987, JAMA.

[20]  R. Suzman,et al.  Health statistics on older persons United States, 1986. , 1987, Vital & health statistics. Series 3, Analytical and epidemiological studies.

[21]  D. Levy,et al.  Cholesterol and mortality. 30 years of follow-up from the Framingham study. , 1987, JAMA.

[22]  J. Cutler,et al.  Serum cholesterol levels and cancer mortality in 361,662 men screened for the Multiple Risk Factor Intervention Trial. , 1987, JAMA.

[23]  P. Greenland,et al.  Feasibility of large-scale cholesterol screening: experience with a portable capillary-blood testing device. , 1987, American journal of public health.

[24]  J. Stamler,et al.  Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. , 1986, Journal of the American College of Cardiology.

[25]  L. Kuller,et al.  SERUM CHOLESTEROL, BLOOD PRESSURE, AND MORTALITY: IMPLICATIONS FROM A COHORT OF 361 662 MEN , 1986, The Lancet.

[26]  M. Shipley,et al.  Plasma cholesterol concentration and death from coronary heart disease: 10 year results of the Whitehall study. , 1986, British medical journal.

[27]  S. Grundy.  Comparison of monounsaturated fatty acids and carbohydrates for lowering plasma cholesterol. , 1986, The New England journal of medicine.

[28]  U. Goldbourt,et al.  Total and high density lipoprotein cholesterol in the serum and risk of mortality: evidence of a threshold effect. , 1985, British medical journal.

[29]  B Buis,et al.  Diet, lipoproteins, and the progression of coronary atherosclerosis. The Leiden Intervention Trial. , 1985, The New England journal of medicine.

[30]  C. Salmond,et al.  Are low cholesterol values associated with excess mortality? , 1985, British medical journal.

[31]  E. Agner.  Some cardiovascular risk markers are also important in old age. , 1985, Acta medica Scandinavica. Supplementum.

[32]  L. Kuller,et al.  Total and cardiovascular mortality in relation to cigarette smoking, serum cholesterol concentration, and diastolic blood pressure among black and white males followed up for five years. , 1984, American heart journal.

[33]  E. Barrett-Connor,et al.  Ischemic heart disease risk factors after age 50. , 1984, Journal of chronic diseases.

[34]  E. Agner,et al.  Fasting serum cholesterol and triglycerides in a ten-year prospective study in old age. , 2009, Acta medica Scandinavica.

[35]  J. Farquhar,et al.  Cholesterol, cancer, and public health policy. , 1983, The American journal of medicine.

[36]  M. Feinleib.  Summary of a workshop on cholesterol and noncardiovascular disease mortality. , 1982, Preventive medicine.

[37]  I. Holme,et al.  EFFECT OF DIET AND SMOKING INTERVENTION ON THE INCIDENCE OF CORONARY HEART DISEASE Report from the Oslo Study Group of a Randomised Trial in Healthy Men , 1981, The Lancet.

[38]  M. Karvonen,et al.  Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study. , 1979, International journal of epidemiology.

[39]  T. Welborn,et al.  Coronary Heart Disease Incidence and Cardiovascular Mortality in Busselton with Reference to Glucose and Insulin Concentrations , 1979, Diabetes Care.

[40]  W. Kannel,et al.  Cholesterol in the prediction of atherosclerotic disease. New perspectives based on the Framingham study. , 1979, Annals of internal medicine.

[41]  M C Hjortland,et al.  Predicting coronary heart disease in middle-aged and older persons. The Framington study. , 1977, JAMA.

[42]  L. Carlson,et al.  Ischaemic heart-disease in relation to fasting values of plasma triglycerides and cholesterol. Stockholm prospective study. , 1972, Lancet.

[43]  W. Kannel,et al.  Serum cholesterol, lipoproteins, and the risk of coronary heart disease. The Framingham study. , 2020, Annals of internal medicine.

[44]  U. Tomiyasu,et al.  A Controlled Clinical Trial of a Diet High in Unsaturated Fat in Preventing Complications of Atherosclerosis , 1969 .