Intended for healthcare professionals


Cholesterol screening and management guidelines

BMJ 1999; 318 doi: (Published 24 April 1999) Cite this as: BMJ 1999;318:1140

Having several guidelines is confusing

  1. Sudha Bulusu, Consultant chemical pathologist. (
  1. Chemical Pathology Department, Newham General Hospital, London E13 8RU
  2. Clinical Pharmacology and Therapeutics Division of Clinical Sciences, Royal Hallamshire Hospital, Sheffield S10 2JF

    EDITOR—Unwin et al highlight the fact that several widely available guidelines for the management of hyperlipidaemia give conflicting advice for the primary prevention of cardiovascular disease.1 Some of the issues deserve further scrutiny.

    The New Zealand guidelines are based entirely on the ratio of total to high density lipoprotein cholesterol concentrations for calculation of the absolute risk of cardiovascular disease over five years.2 The American national cholesterol education program, however, clearly says that it does not recommend use of the ratio of either total or low density lipoprotein cholesterol to high density lipoprotein cholesterol3; instead it recommends use of the absolute high and low density lipoprotein cholesterol concentrations. The rationale behind this is that these concentrations are independent risk factors with different determinants; combining …

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