• screening
• coronary heart disease
• low density lipoprotein
• risk factors

• CHD: coronary heart disease
• CRP: C reactive protein
• CT: computed tomography
• FH: familial hypercholesterolaemia
• HDL: high density lipoprotein
• LDL: low density lipoprotein
• NCEP: US National Cholesterol Education Program
• PAI-1: plasminogen activator inhibitor

Used properly, screening detects metabolic time bombs before they wreak havoc; used inappropriately, screening may transform an asymptomatic individual into a modern semblance of Damocles, perpetually anxious about the future. Hence, before undertaking screening it is important to first answer the question as to whether the results are likely to influence the future management of the person screened. If the answer is no or uncertain, then it might be better to desist.

Familial occurrence of risk factors such as a raised low density lipoprotein (LDL) cholesterol is sometimes caused by a dominantly inherited disorder—for example, familial hypercholesterolaemia (FH)—but more often reflects interaction between weaker genetic traits and shared environmental influences, especially a poor diet. This review focuses mainly on metabolic risk factors causally related to the premature onset of coronary heart disease (CHD) and modifiable by alterations in diet and lifestyle or by drug treatment. Increasing evidence that certain agents, notably statins, can prevent or delay the onset of CHD makes it imperative to screen for dyslipidaemia the relatives of all patients developing or dying from CHD before the age of 55 if male or 65 if female.