Level I Services: Preventive services for which clinicians and health systems must assess the need. These services must be recommended to each patient, as they have the highest value and are worthy of attention at every opportunity.
|The USPSTF recommendations are fully endorsed by the ICSI Preventive Services work group.
||Grade of Recommendation and Level of Certainty as Evaluated by USPSTF|
1. “Screening men age 35 years and older for lipid disorders.”
2. “Screening men ages 20 to 35 years for lipid disorders if they are at increased risk for coronary heart disease.”
Women at increased risk
3. “Screening men ages 20 to 35 years for lipid disorders if they are at increased risk for coronary heart disease.”
4. “Screening women age 45 years and older for lipid disorders if they are at increased risk for coronary heart disease.”
Young men and all women not at increased risk
5. “No recommendation for or against routine screening for lipid disorders in men ages 20 to 35 years or women age 20 years and older who are not at increased risk for coronary heart disease.”
(USPSTF Last Revised 2008 – Update in Progress)
|Grade of Recommendation:
Level of Certainty:
There is good evidence that lipid-lowering drug therapy substantially decreases the incidence of coronary heart disease in persons with abnormal lipids. The absolute benefits of lipid-lowering treatment depend on a person's underlying risk for coronary heart disease. Men over the age of 35 and women over the age of 45 who are at increased risk will realize a substantial benefit from treatment; younger adults with multiple risk factors for coronary disease, including dyslipidemia, will realize a moderate benefit from treatment; and younger men and women without risk factors for coronary heart disease will realize a small benefit from treatment, as seen in the risk reduction in 10-year CHD event rate.
There is good evidence that the harms from screening and treatment are small and include possible labeling and the adverse effects associated with lipid-lowering therapy (e.g., rhabdomyolysis).
The USPSTF concludes that the benefits of screening for and treating lipid disorders in all men age 35 years and older and women age 45 years and older at increased risk for coronary heart disease substantially outweigh the potential harms.
The USPSTF concludes that the benefits of screening for and treating lipid disorders in young adults at increased risk for coronary heart disease moderately outweigh the potential harms.
The USPSTF concludes that the net benefits of screening for lipid disorders in young adults not at increased risk for coronary heart disease are not sufficient to make a general recommendation.
Assessment of Risk:
Increased risk, for the purposes of this recommendation, is defined by the presence of any one of the risk factors listed below. The greatest risk for CHD is conferred by a combination of multiple listed factors. While the USPSTF did not use a specific numerical risk to bound this recommendation, the framework used by the USPSTF in making these recommendations relies on a 10-year risk of cardiovascular events:
|ICSI Supplemental Information:
For additional resources refer to the ICSI Lipid Management in Adults document.