Cholesterol tests wasted on 'worried well'

Cholesterol testing is not being offered to those most at risk of developing heart disease, according to the British Cardiac Society.

Instead it is the "worried well" - the health conscious and educated - who are putting doctors under pressure to give them tests.

A survey carried out in Scotland as part of the Glasgow Monitoring Cardiac Disease Project (Monica) found that three-quarters of patients tested were those considered to be at lowest risk.

The study of 2,000 men and women between 25 and 74 assessed common risk factors such as smoking, high blood pressure, diabetes, and evidence of heart disease.

Coronary heart disease is the single most common cause of death in the UK and the industrialised world. A high level of cholesterol in the blood is a significant risk factor for coronary heart disease and people with a high level can be treated with dietary advice and if necessary cholesterol lowering drugs to help reduce their risk of developing CHD. In 1993, 70 per cent of UK adults had high cholesterol levels.

Last year a study by the West of Scotland Coronary Prevention Study Trial found that using a cholesterol lowering drug reduced heart attacks by nearly one-third and the risk of death by 22 per cent.

In the Monica study 20 per cent had been tested for cholesterol over the year. But only one in five of this 20 per cent had existing heart disease and only one in 20 had factors placing them at high risk of developing CHD.

"It's the people at high risk we want to target," said Dr Caroline Morrison, consultant in public health medicine who carried out the survey. "The survey clearly shows that many high risk people are not being offered cholesterol testing whereas many at comparatively low risk are being tested unnecessarily."

At their annual meeting in Glasgow this week the British Cardiac Society is also calling for GPs to play a more important role in administering "clot-busting" drugs to heart attack patients.

Trials of drugs such as streptokinase have shown that they can reduce the likelihood of death from a heart attack by 25 to 50 per cent. The earlier a treatment is started the greater a patient's chances of survival. The British Heart Foundation has recommended that heart attack patients should receive thrombolysis (treatment with clot dissolving drugs) within 90 minutes of seeking medical help - the "call-to-needle" time.

A survey of 326 patients carried out by Dr John Rawles at the Medicine Assessment Research Unit at the University of Aberdeen found that those treated with the drugs by their GPs were more likely to receive the treatment within 90 minutes than those who received it after being admitted to hospital.

Dr Rawles said: "In most cases general practitioners attending patients suffering a heart attack are in a position to give potentially life-saving treatment within the target time [90 minutes]."