When a national panel of experts on heart disease recommended five years ago that all men and women over the age of 20 have their cholesterol levels checked, Baby Boomers flocked by the millions to do just that.
Now, a team of specialists who have calculated the costs, the effectiveness and even the possible hazards of drug treatments designed to lower cholesterol in young adults have come to a controversial conclusion.
In a report published Wednesday, the researchers argue that routine testing of cholesterol levels in all men under the age of 35 and all women under 45 is wholly unnecessary, possibly unethical and a gross waste of money unless the young adults are already known to have coronary heart disease or other serious risk factors.
Treating above-normal cholesterol levels in those young people with the most widely used drugs, the researchers maintain, could pose unknown dangers because the long-term effects of the cholesterol-lowering drugs begun in early life are still unknown.
The report appears in the Journal of the American Medical Association and comes from a group at the University of California at San Francisco and Stanford University. Dr. Stephen Hulley, chief of clinical epidemiology at the San Francisco institution, directed the study.
It was promptly denounced as misleading and perhaps dangerous by one expert. He insisted that if severely high cholesterol levels in young adults remained undetected, those men and women would be needlessly threatened when such simple steps as diet and lifestyle changes could lower their cholesterol toward normal and help protect against later coronary disease.
Cholesterol testing for all adults should be a routine part of every medical checkup-just as advice about smoking, proper weight and diet are-said Dr. Basil Rifkind, a specialist on cholesterol and heart disease at the National Institutes of Health. He was a major participant in the national study five years ago that urged screening for all adults, young and old.
Although excessively high cholesterol levels are only one aspect of the heart disease problem, they are significant.
Coronary heart disease kills more than 500,000 Americans every year, with the toll almost evenly divided among men and women.
Hulley and his colleagues said they based their arguments on analyses of scores of large-scale studies, and on the fact that coronary heart disease is extremely rare in men under 35 and premenopausal women.
The studies, involving thousands of men whose cholesterol levels were lowered with drugs even although they had no previous signs of heart disease, showed a far greater risk of deaths from cancer than from heart attacks, Hulley and his colleagues found.
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Their conclusion: In healthy young adults the most widely used cholesterol-lowering drugs themselves may well be causing death as a result of long-term use.
According to Hulley and his colleagues, there is a widely held belief that attempts to lower cholesterol levels at an early age are more effective in preventing deaths from heart disease than efforts begun in middle age.
In fact, the researchers say, there is no direct evidence that this is true, and coronary heart disease can just as effectively be prevented when treatment to lower cholesterol levels begins in middle age.
The 1988 recommendation for widespread cholesterol screening and treatment of all adults came from a panel of experts named by the government’s National Cholesterol Education Program.
According to Rifkind, an updated report from that panel will be released in June and it will adopt a more conservative approach to drug treatment for younger adults with high levels of cholesterol.