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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.

The study findings will help doctors target cholesterol-lowering drugs, such as statins, to the patients who most need them.

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. The study findings 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.

Further information:

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.

Length of project:

Jan 12 – Nov 15 



Health Technology Assessment (NIHR HTA) Programme (project number 10/97/01)

External Collaborators:

  • Melbourne School of Population and Global Health, The University of Melbourne, Australia: Tom Lung and Phillip Clarke
  • Bond University, Gold Coast, Queensland, Australia: Paul Glasziou
  • Sydney School of Public Health, University of Sydney, Australia: Les Irwig
  • St.Luke's Life Science Institute, St Luke’s International Hospital, Tokyo, Japan: Osamu Takahashi, Asuka Leslie, Sachiko Ohde, Gautham Deshpande and Kevin Urayama
  • Oxford University Hospitals Trust, Oxford, UK: Brian Shine.

Video from the Monitoring Dissemination Meeting
The role of early dissemination meetings in the research process