Blood cholesterol is an important risk factor for CHD but should be considered in the context of other risk factors such as smoking, raised blood pressure and physical inactivity. Blood cholesterol alone is a relatively poor predictor of individual CHD risk. The majority of CHD events occur in people with average or low blood cholesterol levels. Consequently, cholesterol screening is unlikely to reduce mortality and can be misleading or even harmful.
Cholesterol lowering using statins is effective at reducing CHD mortality and morbidity.
Therapy should be targeted at people who are at high risk of coronary heart disease rather than be based upon cholesterol levels. In asymptomatic people, at low risk of coronary heart disease, the costs of cholesterol lowering using statins are high relative to the benefits and their use is contentious. Cholesterol lowering is one of a number of methods of reducing the risk of cardiovascular disease. Greater priority should be given to the appropriate use of other drug treatments and non-pharmacological interventions in the primary and secondary prevention of coronary heart disease.