Consequences of the National Cholesterol Education Program

The National Cholesterol Education Program (NCEP) has established guidelines for detecting, evaluating, and treating elevated blood cholesterol levels in adults. The program has been endorsed by 24 medical organizations nationwide. However, it is estimated that the cost of screening of all adults will be greater than $12 billion. This does not include the cost of treating and monitoring the estimated 117 million patients who will be identified. The repercussions of this program are considered. Interpretation of the results of screening is complicated and variations among laboratories may occur. The initial impetus for creating the NCEP was the evidence of decreased incidence of nonfatal myocardial infarction (heart attack) in patients treated for elevated serum cholesterol levels. However, the patients who were treated showed a trend for increased stomach and bowel cancer. The population studied were middle-aged men; women have a lower morbidity from heart disease. Also, elevated cholesterol levels in the elderly do not predict heart disease or death. The value of universal cholesterol testing is questioned. After careful review of the evidence, some have recommended that testing and treatment for elevated cholesterol should be individualized. In the United Kingdom, the Royal College of Physicians has rejected the concept of universal screening, and the Committee on Nutrition 1988-1989 has recommended against universal cholesterol testing in children. The minor decrease in morbidity seen in middle-aged men treated for elevated cholesterol does not appear to balance the costs and possible harm to patients, physicians, and the general public. Medical organizations should reconsider their endorsement of NCEP. (Consumer Summary produced by Reliance Medical Information, Inc.)