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Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease 

Full project title

Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: systematic Review with statistical and cost-effectiveness modelling


There are several alternative ways to measure cholesterol (“lipids”). We studied which cholesterol measures are most strongly associated with future heart disease, and the appropriate length of time to leave between one cholesterol test and the next.

Why is this important?

There is a clear relationship between cholesterol levels and the risk of heart disease (including heart attack and stroke). It is common that, together with other factors such as blood pressure, cholesterol levels are measured at regular intervals to determine a person’s risk of heart disease and hence decide whether cholesterol-lowering drugs (statins) should be prescribed. However, over short time periods, cholesterol measures may vary more by chance than by any real change in health status, so testing too frequently may be counter-productive.

Methods and findings

Firstly, we compiled information from previous studies and found that, in general, combinations of cholesterol measures (e.g. the ratio of two types of cholesterol) show stronger associations with heart disease than single measures. We used similar methods to study the effects of statins on cholesterol. This confirmed that effects are greater at higher doses. Finally we used computer models based on routine general practice data to estimate the levels of treatment, financial costs, and rates of outcomes such as heart disease, if cholesterol is measured every one, two, three or five years. Based on our models, the shorter the interval, the larger the number of people that will be eligible for treatment.

How this could benefit patients

Our research will help the NHS, and other bodies that publish clinical guidelines (such as the National Institute for Health and Care Excellence, NICE), to provide well-informed recommendations on cholesterol testing.  This will help doctors target cholesterol-lowering drugs, such as statins, to the patients who most need them.

Next steps

We are now using similar methods to study the monitoring of other conditions in primary care, such as chronic kidney disease and heart failure.


This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 10/97/01) and will be published in full in Health Technology Assessment

Department team members:

Rafael Perera, Emily McFadden, Julie McLellan, Richard Stevens, Tom Fanshawe, Teresa Perez, Andrew Dalton, Andrew Farmer, Jenny Hirst, Sarah Stevens

External collaborators

Tom Lung and Phillip Clarke: Melbourne School of Population and Global Health, The University of Melbourne, Australia

Paul Glasziou: Bond University, Gold Coast, Queensland, Australia

Les Irwig: Sydney School of Public Health, University of Sydney, Australia

Osamu Takahashi, Asuka Leslie, Sachiko Ohde, Gautham Deshpande and Kevin Urayama:  St.Luke's Life Science Institute, St Luke’s International Hospital, Tokyo, Japan

Brian Shine: Oxford University Hospitals Trust, Oxford, UK 



Video from the Monitoring Dissemination Meeting

The role of early dissemination meetings in the research process


Final report accepted 19th December 2015.  

Publication expected September 2015.

For further information please contact Emily McFadden.

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