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- Title
Lipid screening to prevent coronary artery disease: a quantitative evaluation of evolving guidelines.
- Authors
Grover, Steven A.; Dorais, Marc; Paradis, Gilles; Fodor, J. George; Frohlich, Jiri J.; McPherson, Ruth; Coupal, Louis; Zowall, Hanna
- Abstract
AbstractBackground: There is strong evidence to support the treatment of abnormal blood lipid levels among people with cardiovascular disease. Primary prevention is problematic because many individuals with lipid abnormalities may never actually develop cardiovascular disease. We evaluated the 1998 Canadian lipid guidelines to determine whether they accurately identify high-risk adults for primary prevention.Methods: Using data from the Lipid Research Clinics and receiver operating characteristic (ROC) curves, we compared the diagnostic performance of the 1998 lipid guidelines when risk factors for coronary artery disease (CAD) were counted versus calculating risk using Framingham risk equations. We also compared the diagnostic accuracy of the 1998 guidelines with guidelines previously published by the National Cholesterol Education Program in the United States and the 1988 Canadian Consensus Conference on Cholesterol and then used Canadian Heart Health Survey data to forecast lipid screening and treatment rates for the Canadian population.Results: The Framingham risk equations were more accurate than counting risk factors for predicting CAD risk (areas under the ROC curves, 0.83 [standard deviation (SD) 0.02] v. 0.77 [SD 0.03], p < 0.05). Risk counting was a particularly poor method for predicting risk for women. The 1998 Canadian guidelines identified high-risk individuals more accurately than the earlier guidelines, but the increased accuracy was largely due to a lower false-positive rate or a higher true-negative rate (i.e., increased test specificity). Using the 1998 lipid guidelines we estimate that 5.9 million Canadians currently free of cardiovascular disease would be eligible for lipid screening and 322 705 (5.5%) would require therapy.Interpretation: Calculating risk using risk equations is a more accurate method to identify people at high risk for CAD than counting the number of risk factors present, especially for women, and the 1998 Canadian lipi...
- Subjects
BLOOD lipids; CORONARY heart disease risk factors; HEALTH risk assessment; CARDIOVASCULAR disease prevention; MEASUREMENT
- Publication
Canadian Medical Association Journal (CMAJ), 2000, Vol 163, Issue 10, p1263
- Publication type
Article