Universal screening for cholesterol should be abandoned, the powerful American College of Physicians (ACP) has decreed. Those aged over 75 can safely ignore any screening because cholesterol is not a risk factor in this age group, the ACP surprisingl

The ACP recommendations have generated a storm of protest from some medical quarters, and are completely at variance with the guidelines set by the US National Cholesterol Education program, which advocates screening for everyone over the age of 20 every five years, irrespective of risk factors.

But the ACP could not come up with the same conclusion after analyzing trials into middle aged men. It carried out its own original analysis of data to produce its own findings for those groups not already covered by existing trials.

Its guidelines, sent to all American physicians, says: routine cholesterol screening is "appropriate but not mandatory" for healthy, cardiac risk free men aged between 35 and 65 and women aged 45 to 85.

Routine screening is not recommended in the over 75s.

Routine screening is not recommended for men younger than 35 or women younger than 45 unless they have a family history of heart problems, or have more than two risk factors. The risk factors are: being male, high blood pressure, cigarette smoking, and diabetes.

Those for whom screening is appropriate should be tested only for total cholesterol levels, and not for low density or high density lipoprotein (The Lancet, March 9, 1996).

Yet another study has confirmed the benefits of fish oils to people who have suffered a heart attack. Researchers from Aalborg Hospital in Denmark have found that fish oils marine n-3 polyunsaturated fatty acids protected against irregular heart beat because it increases heart rate variability. They note that high risk patients enjoy a far higher survival rate if they are given beta blockers or ACE inhibitors, both of which increase heart rate variability.

!ABMJ, March 16, 1996.