Too Many Cholesterol Tests?

Coronary heart disease patients who reach target cholesterol levels may receive redundant testing

(RxWiki News) Lipid panels are tests used to measure cholesterol in blood. While these tests can indicate a possible risk for heart disease, many heart patients may be getting unnecessary testing.

Screening is key to detecting high cholesterol and obtaining early treatment. But a new analysis has found that lipid testing may be overused. This study found coronary heart disease patients who have reached their LDL goals may not benefit from further tests. 

This researcher said, "These low-cost, high-volume tests and procedures need to be addressed if significant savings from reduction of waste are to be realized."

"Ask a doctor about cholesterol testing."

Salim Virani, MD, of the Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence in Houston, Texas, and his colleagues analyzed a total of 35,191 patients with coronary heart disease. The patients were from a Veterans Administration (VA) network of seven medical centers.

LDL stands for low-density lipoprotein. LDL cholesterol is known as the "bad" cholesterol because it can slowly build up in the inner walls of the arteries and combine with other substances to form plaque. This plaque can clog arteries, which increases the risk of heart attack and stroke.

In this study, a total of 27,947 patients reached recommended LDL goals. The recommended LDL target is less than 100 mg/dL (milligrams per deciliter), according to the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program.

One-third of these individuals (9,200) had repeat lipid testing without additional intensification of treatment over 11 months of the study.

About 13,114 patients met an optional LDL cholesterol target level of less than 70 mg/dL, and almost two-thirds of these patients (8,177) had repeat lipid testing during 11 follow-up months.

The American Heart Association (AHA) says that an LDL of less than 70 mg/dL should be the goal for people at very high risk of a heart attack or sudden death. The goal for everyone else is less than 100 mg/dL.

Of the 9,200 patients who met the less than 100 mg/dL goal, 12,686 additional lipid panels were performed.

"With a mean lipid panel cost of $16.08...this is equivalent to $203,990 in annual costs for one VA network and does not take into account the cost of the patient's time to undergo lipid testing and the cost of the provider's time to manage these results and notify the patient," the study authors wrote.

Dr. Virani and his team added that, in these patients, "...repeat lipid testing may represent health resource overuse and possibly waste of health care resources."

The results suggest that initiatives are needed to reduce repeat testing, according to the authors.

In a related commentary, Joseph Drozda, Jr., MD, with the Center for Innovative Care in Chesterfield, Missouri, wrote, "The investigators conclude that this represents redundant testing and is a target for quality improvement efforts."

This study was published in July in JAMA Internal Medicine.

This work was also supported by a Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence grant and by a Veterans Affairs contract.

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Review Date: 
July 8, 2013