High Blood Cholesterol: who should be treated, and how?

Abstract

Key Points 'Who should be treated? The entire population, high risk individuals only, both, or neither? We know too much about the hazards of high blood cholesterol to do neither, and there is general agreement that high- risk individuals should be treated (though the definition of what constitutes high risk may vary). The decision on whether to treat the entire population depends on the population diagnosis - if it is a "sick" population, then like sick individuals, it should be treated. A sick population could be defined as one in which the rate of coronary disease is high by world standards, and in which the majority have risk factors for coronary disease. That is the situation in many of South Africa's population groups. The numbers who need risk factor management are then so large that individual clinical treatment becomes impossible for any but those at the very highest risk for the mass of people health education and environmental change are needed to move their risk orofil6 in a favourable direction."