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Lipid Re-screening: What Is the Best Measure and Interval?
  1. Osamu Takahashi (otakahas{at}gmail.com)
  1. Department of Primary Health Care, University of Oxford, United Kingdom
    1. Paul P Glasziou (paul.glasziou{at}dphpc.ox.ac.uk)
    1. Department of Primary Health Care, University of Oxford, United Kingdom
      1. Rafael Perera (rafael.perera{at}dphpc.ox.ac.uk)
      1. Department of Primary Health Care, University of Oxford, United Kingdom
        1. Takuro Shimbo
        1. Department of Clinical Research and Informatics, International Medical Centre of Japan, Japan
          1. Jiro Suwa
          1. Centre for Preventive Medicine, St. Luke's International Hospital, Japan
            1. Sonoe Hiramatsu
            1. Centre for Preventive Medicine, St. Luke's International Hospital, Japan
              1. Tsuguya Fukui
              1. Division of General Internal Medicin, Department of Medicine, St. Luke's International Hospital, Japan

                Abstract

                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.

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