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Lipid re-screening: What is the best measure and interval?
Heart (2010)
  • Osamu Takahashi, University of Oxford
  • Paul P Glasziou, University of Oxford
  • Rafael Perera, University of Oxford
  • Takuro Shimbo
  • Jiro Suwa
  • Sonoe Hiramatsu
  • Tsuguya Fukui

Objectives: To estimate the long-term true change variation ("signal") and short-term within-person variation ("noise") of the different lipids measures and evaluate the best measure and the optimal interval for lipid re-screening.

Design: Retrospective cohort study from 2005 to 2008.

Setting: Centre for Preventive Medicine at a teaching hospital in Tokyo, Japan.

Participants: 15810 adults not taking cholesterol-lowering medications at baseline.

Main outcome measures: Annual measurement of the serum total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and calculated the ratio of TC/HDL and LDL/HDL. We estimated the ratio of long-term drift ("signal") to the short-term within-person variation ("noise") for each measure.

Results: At baseline, participants (53% male) with a mean age of 49 years old (range: 21 to 92) and a mean TC level of 5.3 mmol/L (SD, 0.9 mmol/L) had annual check-ups over 4 years. Short-term within-person variations of TC, LDL, HDL, TC/HDL, and LDL/HDL were 0.12 (coefficient of variation (CV), 6.4%), 0.08 (CV: 9.4%), 0.02 (CV: 8.0%), 0.08 (CV: 7.9%) and 0.05(CV: 10.6%) mmol2/L2 respectively. The ratio of signal to noise at 3 years was largest for TC/HDL (1.6), followed by LDL/HDL (1.5), LDL (0.99), TC (0.8), and HDL (0.7), suggesting cholesterol ratios are more sensitive re-screening measures.

Conclusion: The signal-to-noise ratios of standard single lipid measures (TC, LDL, and HDL) are weak over 3 years and decisions based on these measures are potentially misleading. The ratio, TC/HDL and LDL/HDL, appears to be better measure for monitoring assessments. The lipid re-screening interval should be more than 3 years for those not taking cholesterol-lowering drugs.

  • lipids measures,
  • variation,
  • re-screening,
  • interval
Publication Date
March 1, 2010
Publisher Statement
Interim status: Citation only.

Takahashi, O., Glasziou, P.P., Perera, R., Shimbo, T., Suwa, J., Hiramatsu, S. & Fukui, T. (2010). Lipid re-screening: What is the best measure and interval? Heart, 96(6), 448-452.

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© Copyright Heart, 2009
Citation Information
Osamu Takahashi, Paul P Glasziou, Rafael Perera, Takuro Shimbo, et al.. "Lipid re-screening: What is the best measure and interval?" Heart Vol. 96 Iss. 6 (2010)
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