The rise of cholesterol testing: how much is unnecessary

Abstract

Laboratory testing has increased dramatically over recent decades, which is a consequence particularly of repeat testing or monitoring, as either a response to treatment or follow-up. AimTo assess rates of measurement of lipid levels (total cholesterol, high-density lipoprotein, triglyceride) for diagnosis and monitoring over the last 20 years. Design of studyAudit of electronic database. SettingA single region in the UK (Oxfordshire). MethodSpecimens from individual patients were matched over time. All tests that were the third or more in a 3-year period were considered to be for monitoring, while the first and second were considered to be for diagnosis. As recent evidence-based recommendations suggest that frequent monitoring of cholesterol may reflect measurement error rather than true changes, between one and three tests in each 3-year period were considered to be 'necessary'. ResultsOver the 20 years from 1987 there has been a more than 15-fold rise in the overall number of lipid tests requested. After a small decline in the early 1990s, testing rose steadily after publication of several large statin trials, particularly tests requested in primary rather than secondary care. Repeat testing (likely to be for monitoring) rose from 24% of tests (1993-1995) to 61% (2005-2007) ConclusionIn the last decade, the number of cholesterol tests performed in Oxfordshire has risen dramatically. Much of this appears to be for monitoring purposes rather than case finding or risk assessment. The majority of cholesterol tests requested may be unnecessary.

Variations in lipid screening frequency in family medicine patients with cardiovascular risk factors

“…Moreover, these screening requests were ordered particularly from primary care centres rather than secondary health care facilities. Re‐screening tests, most likely to be for monitoring, increased sharply from the rates of 24% (1993–1995) to the 61% (2005–2007) of which majorities were inappropriate for achieving lipid parameters goals [9]. In accordance with this study, our study also has an incremental rate of inappropriate testing on all three baseline (semi‐annual, annual, biennial) screening intervals.…”

“…Furthermore, false‐positive results may lead to inappropriate treatment modalities [10,11]. The importance of biomarkers, the easiness to obtain and react to them such as lipid levels has led their adoption as quality indicators [12], which may contribute to pressures for increased frequency of lipid testing [9].…”

“…Lipid analysis plays a vital role in estimating an individual's global risk of CHD [8]. The lipid panel includes high total cholesterol (TC), high low-density lipoprotein (LDL), triglycerides (TG) and low high-density lipoprotein (HDL) cholesterol, which are closely linked with increased atherosclerotic burden [9]. Identifying dyslipidaemia and starting lipid-lowering interventions such as lifestyle modifications followed if necessary by medical therapy could decrease the risk of CVD.…”

Emerging diagnostic technologies in primary care: what’s on the horizon?

“…But GPs do have good access to almost all of the same blood tests that are available to hospital settings, indeed the numbers of blood tests performed in general practice has increased dramatically in recent years. Much of this increase is driven by guidelines to screen more patients and monitor them more frequently, 1 and additional factors include diagnostic uncertainty, patient anxiety, and litigation, among others. This is not to downplay the key role that history and examination plays in directing further clinical assessment, but many symptoms and signs are insufficient to rule in or rule out particular diagnoses, or to monitor patients with chronic diseases.…”

Which lipid measurement should we monitor? An analysis of the LIPID study

“…Since the marketing of 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors, lipid measurement workloads have increased markedly 1. Much of this testing appears to be for monitoring rather than screening.…”