Action limits for serum total cholesterol - a statement for the medical profession by an ad hoc committee of the Heart Foundation of Southern Africa

Summary Hypercholesterolaemia is common in many segments of the South African population, both by virtue of . high mean population serum total cholesterol (TC) values and of a high prevalence of familial hyper­ cholesterolaemia (FH). Age-specific action limits for TC are proposed in order to remove the variation in 'normal values' used by different laboratories. The action limits are derived from epidemiological studies rather than purely statistical norms. They are used to designate individuals as falling into high, moderate and ideal TC ranges. The high-risk action limit has also proved to be useful for screening for FH. After an initial screening TC estimation, the further management of a patient will depend on the TC risk category and the presence or absence of other risk factors. Risk factors such as hypertension, a smoking habit, a low high-density lipoprotein cholesterol value, diabetes, evidence of existing coronary heart disease (CHD) or a family history of premature CHD multiply the risk conferred by elevated TC, and change the moderate-risk status of an individual with moderately elevated TC to a high-risk status. Intensity of investi­ gation, treatment and follow-up depend on the overall risk status of an individual patient. Drug therapy is reserved for high-risk patients who have not re­ sponded to a reasonable trial of non-drug measures. Other reversible risk factors are treated in their own right. The guidelines embodied in this report are intended to facilitate and justify the clinical approach to indi­ vidual patients with hypercholesterolaemia. They do