Lipid re-screening: What is the best measure and interval?

Osamu Takahashi, Paul P. Glasziou, Rafael Perera, Takuro Shimbo, Jiro Suwa, Sonoe Hiramatsu, Tsuguya Fukui

Research output: Contribution to journalArticleResearchpeer-review

28 Citations (Scopus)

Abstract

Objectives: To estimate the long-term true change variation ('signal') and short-term within-person variation ('noise') of the different lipid measures and evaluate the best measure and the optimal interval for lipid rescreening. Design: Retrospective cohort study from 2005 to 2008. Setting: A medical health check-up programme at a centre for preventive medicine in a teaching hospital in Tokyo, Japan. Participants: 15 810 apparently healthy Japanese adults not taking cholesterol-lowering drugs at baseline, with a mean body mass index of 22.5 kg/m2 (SD 3.2). Main outcome measures: Annual measurement of the serum total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and calculation of the ratio of TC/HDL and LDL/HDL. Measurement of the ratio of long-term true change variation ('signal') to the short-term within-person variation ('noise') for each measure. Results: At baseline, participants (53% male) with a mean age of 49 years (range 21-92) and a mean TC level of 5.3 mmol/l (SD 0.9 mmol/l) had annual check-ups over 4 years. Short-term within-person variations of TC, LDL, HDL, TC/HDL, and LDL/HDL were 0.12 (coefficient of variation (CV) 6.4%), 0.08 (CV 9.4%), 0.02 (CV 8.0%) mmol2/l2, 0.08 (CV 7.9%) and 0.05 (CV 10.6%), respectively. The ratio of signal-to-noise at 3 years was largest for TC/HDL (1.6), followed by LDL/HDL (1.5), LDL (0.99), TC (0.8) and HDL (0.7), suggesting that cholesterol ratios are more sensitive re-screening measures. Conclusion: The signal-to-noise ratios of standard single lipid measures (TC, LDL and HDL) are weak over 3 years and decisions based on these measures are potentially misleading. The ratios, TC/HDL and LDL/HDL, seem to be better measures for monitoring assessments. The lipid rescreening interval should be >3 years for those not taking cholesterol-lowering drugs.

Original languageEnglish
Pages (from-to)448-452
Number of pages5
JournalHeart
Volume96
Issue number6
DOIs
Publication statusPublished - Mar 2010
Externally publishedYes

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HDL Lipoproteins
HDL Cholesterol
LDL Lipoproteins
Lipids
Cholesterol
LDL Cholesterol
Signal-To-Noise Ratio
Noise
Preventive Medicine
Tokyo
Teaching Hospitals
Pharmaceutical Preparations
Japan
Body Mass Index
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Health
Serum

Cite this

Takahashi, O., Glasziou, P. P., Perera, R., Shimbo, T., Suwa, J., Hiramatsu, S., & Fukui, T. (2010). Lipid re-screening: What is the best measure and interval? Heart, 96(6), 448-452. https://doi.org/10.1136/hrt.2009.172619
Takahashi, Osamu ; Glasziou, Paul P. ; Perera, Rafael ; Shimbo, Takuro ; Suwa, Jiro ; Hiramatsu, Sonoe ; Fukui, Tsuguya. / Lipid re-screening : What is the best measure and interval?. In: Heart. 2010 ; Vol. 96, No. 6. pp. 448-452.
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abstract = "Objectives: To estimate the long-term true change variation ('signal') and short-term within-person variation ('noise') of the different lipid measures and evaluate the best measure and the optimal interval for lipid rescreening. Design: Retrospective cohort study from 2005 to 2008. Setting: A medical health check-up programme at a centre for preventive medicine in a teaching hospital in Tokyo, Japan. Participants: 15 810 apparently healthy Japanese adults not taking cholesterol-lowering drugs at baseline, with a mean body mass index of 22.5 kg/m2 (SD 3.2). Main outcome measures: Annual measurement of the serum total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and calculation of the ratio of TC/HDL and LDL/HDL. Measurement of the ratio of long-term true change variation ('signal') to the short-term within-person variation ('noise') for each measure. Results: At baseline, participants (53{\%} male) with a mean age of 49 years (range 21-92) and a mean TC level of 5.3 mmol/l (SD 0.9 mmol/l) had annual check-ups over 4 years. Short-term within-person variations of TC, LDL, HDL, TC/HDL, and LDL/HDL were 0.12 (coefficient of variation (CV) 6.4{\%}), 0.08 (CV 9.4{\%}), 0.02 (CV 8.0{\%}) mmol2/l2, 0.08 (CV 7.9{\%}) and 0.05 (CV 10.6{\%}), respectively. The ratio of signal-to-noise at 3 years was largest for TC/HDL (1.6), followed by LDL/HDL (1.5), LDL (0.99), TC (0.8) and HDL (0.7), suggesting that cholesterol ratios are more sensitive re-screening measures. Conclusion: The signal-to-noise ratios of standard single lipid measures (TC, LDL and HDL) are weak over 3 years and decisions based on these measures are potentially misleading. The ratios, TC/HDL and LDL/HDL, seem to be better measures for monitoring assessments. The lipid rescreening interval should be >3 years for those not taking cholesterol-lowering drugs.",
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Takahashi, O, Glasziou, PP, Perera, R, Shimbo, T, Suwa, J, Hiramatsu, S & Fukui, T 2010, 'Lipid re-screening: What is the best measure and interval?' Heart, vol. 96, no. 6, pp. 448-452. https://doi.org/10.1136/hrt.2009.172619

Lipid re-screening : What is the best measure and interval? / Takahashi, Osamu; Glasziou, Paul P.; Perera, Rafael; Shimbo, Takuro; Suwa, Jiro; Hiramatsu, Sonoe; Fukui, Tsuguya.

In: Heart, Vol. 96, No. 6, 03.2010, p. 448-452.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Lipid re-screening

T2 - What is the best measure and interval?

AU - Takahashi, Osamu

AU - Glasziou, Paul P.

AU - Perera, Rafael

AU - Shimbo, Takuro

AU - Suwa, Jiro

AU - Hiramatsu, Sonoe

AU - Fukui, Tsuguya

PY - 2010/3

Y1 - 2010/3

N2 - Objectives: To estimate the long-term true change variation ('signal') and short-term within-person variation ('noise') of the different lipid measures and evaluate the best measure and the optimal interval for lipid rescreening. Design: Retrospective cohort study from 2005 to 2008. Setting: A medical health check-up programme at a centre for preventive medicine in a teaching hospital in Tokyo, Japan. Participants: 15 810 apparently healthy Japanese adults not taking cholesterol-lowering drugs at baseline, with a mean body mass index of 22.5 kg/m2 (SD 3.2). Main outcome measures: Annual measurement of the serum total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and calculation of the ratio of TC/HDL and LDL/HDL. Measurement of the ratio of long-term true change variation ('signal') to the short-term within-person variation ('noise') for each measure. Results: At baseline, participants (53% male) with a mean age of 49 years (range 21-92) and a mean TC level of 5.3 mmol/l (SD 0.9 mmol/l) had annual check-ups over 4 years. Short-term within-person variations of TC, LDL, HDL, TC/HDL, and LDL/HDL were 0.12 (coefficient of variation (CV) 6.4%), 0.08 (CV 9.4%), 0.02 (CV 8.0%) mmol2/l2, 0.08 (CV 7.9%) and 0.05 (CV 10.6%), respectively. The ratio of signal-to-noise at 3 years was largest for TC/HDL (1.6), followed by LDL/HDL (1.5), LDL (0.99), TC (0.8) and HDL (0.7), suggesting that cholesterol ratios are more sensitive re-screening measures. Conclusion: The signal-to-noise ratios of standard single lipid measures (TC, LDL and HDL) are weak over 3 years and decisions based on these measures are potentially misleading. The ratios, TC/HDL and LDL/HDL, seem to be better measures for monitoring assessments. The lipid rescreening interval should be >3 years for those not taking cholesterol-lowering drugs.

AB - Objectives: To estimate the long-term true change variation ('signal') and short-term within-person variation ('noise') of the different lipid measures and evaluate the best measure and the optimal interval for lipid rescreening. Design: Retrospective cohort study from 2005 to 2008. Setting: A medical health check-up programme at a centre for preventive medicine in a teaching hospital in Tokyo, Japan. Participants: 15 810 apparently healthy Japanese adults not taking cholesterol-lowering drugs at baseline, with a mean body mass index of 22.5 kg/m2 (SD 3.2). Main outcome measures: Annual measurement of the serum total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and calculation of the ratio of TC/HDL and LDL/HDL. Measurement of the ratio of long-term true change variation ('signal') to the short-term within-person variation ('noise') for each measure. Results: At baseline, participants (53% male) with a mean age of 49 years (range 21-92) and a mean TC level of 5.3 mmol/l (SD 0.9 mmol/l) had annual check-ups over 4 years. Short-term within-person variations of TC, LDL, HDL, TC/HDL, and LDL/HDL were 0.12 (coefficient of variation (CV) 6.4%), 0.08 (CV 9.4%), 0.02 (CV 8.0%) mmol2/l2, 0.08 (CV 7.9%) and 0.05 (CV 10.6%), respectively. The ratio of signal-to-noise at 3 years was largest for TC/HDL (1.6), followed by LDL/HDL (1.5), LDL (0.99), TC (0.8) and HDL (0.7), suggesting that cholesterol ratios are more sensitive re-screening measures. Conclusion: The signal-to-noise ratios of standard single lipid measures (TC, LDL and HDL) are weak over 3 years and decisions based on these measures are potentially misleading. The ratios, TC/HDL and LDL/HDL, seem to be better measures for monitoring assessments. The lipid rescreening interval should be >3 years for those not taking cholesterol-lowering drugs.

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Takahashi O, Glasziou PP, Perera R, Shimbo T, Suwa J, Hiramatsu S et al. Lipid re-screening: What is the best measure and interval? Heart. 2010 Mar;96(6):448-452. https://doi.org/10.1136/hrt.2009.172619