At costs lower than $ 0.10 per pill , treating all persons with LDL cholesterol levels greater than 3.4 mmol/L ( > 130 mg/dL ) could be a better strategy .
Previous cost-effectiveness analyses ( 719 ) show that statin therapy is generally cost-effective for secondary prevention and for high-risk primary prevention but do not focus on population -level impact or average cost-effectiveness across the heterogeneous U.S. population , including such subgroups of patients as those with low risk but very high cholesterol levels .
Also , it is unclear whether the ATP III approach to risk stratification , in which risk is formally assessed only for patients with 2 or more established risk factors , is the simplest and most cost-effective way of targeting statin therapy .
The 2004 up date to ATP III ( 3 ) notes that treatment of high-risk subgroups may be useful even when cholesterol levels are low , which suggests that a more purely risk-based approach may be simpler and more cost-effective than the ATP III approach .
Context Which lipid-lowering policies with statins are cost-effective ?
Implication Optimum policies for lipid lowering with statins are highly dependent on statin costs .
The Editors Coronary heart disease ( CHD ) is the leading cause of death in the United States ( 1 ) .
Inhibitors of HMG-CoA reductase , known as statins , lower cholesterol and prevent CHD events and mortality ( 2 , 3 ) .
However , statins are expensive and sometimes cause side effects , which makes it difficult for patients , physicians , and policymakers to decide who should receive them .
The CHD Policy Model is a mathematical state-transition model of CHD in the United States that can be used to project event rates and costs related to CHD .
Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years.
OBJECTIVES To determine whether elevated serum cholesterol level is associated with all-cause mortality , mortality from coronary heart disease , or hospitalization for acute myocardial infa rct ion and unstable angina  in persons older than 70 years . Also , to evaluate the association between low levels of  high-density lipoprotein cholesterol  ( HDL-C ) and elevated ratio of serum cholesterol to HDL-C with these outcomes . DESIGN Prospect i ve , community-based cohort study with yearly interviews . PARTICIPANTS A total of 997 subjects who were interviewed in 1988 as part of the New Haven , Conn , cohort of the Established Population for the Epidemiologic Study of the Elderly ( EPESE ) and consented to have blood drawn . MAIN OUTCOME MEASURES The risk factor-adjusted odds ratios of the 4-year incidence of all-cause mortality , mortality from coronary heart disease , and hospitalization for myocardial infa rct ion or unstable angina were calculated for the following : subjects with total serum cholesterol levels  greater than or equal to 6.20 mmol/L ( > or = 240 mg/dL ) compared with subjects with cholesterol levels less than 5.20 mmol/L ( < 200 mg/dL ) ; subjects in the lowest tertile of HDL-C level compared with those in the highest tertile ; and subjects in the highest tertile of the ratio of total serum cholesterol to HDL-C level compared with those in the lowest tertile . RESULTS Elevated total serum cholesterol level , low HDL-C , and high total serum cholesterol to HDL-C ratio were not associated with a significantly higher rate of all-cause mortality , coronary heart disease mortality , or hospitalization for myocardial infa rct ion or unstable angina after adjustment for cardiovascular risk factors . The risk factor-adjusted odds ratio for all-cause mortality was 0.99 ( 95 % confidence interval [ CI ] , 0.56 to 2.69 ) for the group who had cholesterol levels greater than or equal to 6.20 mmol/L ( > or = 240 mg/dL ) compared with the group that had levels less than 5.20 mmol/L ( < 200 mg/dL ) ; 1.00 ( 95 % CI , 0.59 to 1.70 ) for the group in the lowest tertile of HDL-C compared with those in the highest tertile ; and 1.03 ( 95 % CK , 0.62 to 1.71 ) for subjects in the highest tertile of the ratio of total serum cholesterol to HDL-C compared with those in the lowest tertile . CONCLUSIONS Our findings do not support the hypothesis that hypercholesterolemia or low HDL-C are important risk factors for all-cause mortality , coronary heart disease mortality , or hospitalization for myocardial infa rct ion or unstable angina in this cohort of persons older than 70 years
At costs lower than $ 0.10 per pill , treating all persons with LDL cholesterol levels greater than 3.4 mmol/L ( > 130 mg/dL ) could be a better strategy .
Previous cost-effectiveness analyses ( 719 ) show that statin therapy is generally cost-effective for secondary prevention and for high-risk primary prevention but do not focus on population -level impact or average cost-effectiveness across the heterogeneous U.S. population , including such subgroups of patients as those with low risk but very high cholesterol levels .
Also , it is unclear whether the ATP III approach to risk stratification , in which risk is formally assessed only for patients with 2 or more established risk factors , is the simplest and most cost-effective way of targeting statin therapy .
The 2004 up date to ATP III ( 3 ) notes that treatment of high-risk subgroups may be useful even when cholesterol levels are low , which suggests that a more purely risk-based approach may be simpler and more cost-effective than the ATP III approach .
Context Which lipid-lowering policies with statins are cost-effective ?
Implication Optimum policies for lipid lowering with statins are highly dependent on statin costs .
The Editors Coronary heart disease ( CHD ) is the leading cause of death in the United States ( 1 ) .
Inhibitors of HMG-CoA reductase , known as statins , lower cholesterol and prevent CHD events and mortality ( 2 , 3 ) .
However , statins are expensive and sometimes cause side effects , which makes it difficult for patients , physicians , and policymakers to decide who should receive them .
The CHD Policy Model is a mathematical state-transition model of CHD in the United States that can be used to project event rates and costs related to CHD .