Putting Cholesterol Control on a Diet-Reply

In Reply.— How you look at screening depends on your perspective. On one hand you are interested in identifying cases, and on the other there is the cost of testing many individuals who are not cases. The situation grows complicated when screening for future cases vs future noncases. Dr Thompson has modified Table 4 in our recently published article and chosen to emphasize the percentage of individuals who are not predicted to develop coronary disease over 6 years. It is his conclusion that screening after age 50 years seems to be most productive in identifying cases. Balancing that fact are long-term Framingham survival data from the original cohort showing the strongest associations for cholesterol and mortality in men aged 31 to 47 years and women aged 40 to 47 years. 1 We were cautious about aggressive implementation of the National Cholesterol Education Program algorithm past age 60 years because we