Expert systems: a new dimension for the lab.
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Clinical Laboratory Information Systems↗
Biomedical subjects
P Laemmle
Publications and source records attributed to P Laemmle.
Lack of concordance in classification of coronary heart disease risk: high-risk HDL cholesterol less than 35 mg/dl in subjects with desirable total serum cholesterol, less than 200 mg/dl.
In using National Cholesterol Education Program guidelines (for desirable low risk, a total cholesterol level less than 200 mg/dl, and for high risk, a level of high-density lipoprotein cholesterol (HDLC) less than 35 mg/dl), our specific aim was to examine lack of concordance in classification of coronary heart disease (CHD) risk by HDLC less than 35 mg/dl in subjects with total cholesterol less than 200 and to determine whether lack of concordance increased as group CHD risk increased. We studied four cohorts ranging from putatively low to high CHD risk. These included self-referred subjects in a public urban total cholesterol screening (n = 897), hospitalized patients with depression (n = 144), Cholesterol Center referrals at presumed high CHD risk (n = 1120), and patients having coronary arteriography (n = 145) because of presumed coronary artery disease. Total cholesterol was less than 200 mg/dl in 25% of subjects from the urban sampling, in 54% of hospitalized patients with depression, in 27% of Cholesterol Center referrals, and in 41% of those undergoing cardiac catheterization. In these four cohorts, of subjects with total cholesterol less than 200, 7%, 26%, 25%, and 48%, respectively, had HDLC less than 35 mg/dl. The likelihood of having total cholesterol less than 200 and HDLC less than 35 mg/dl was 1.7% in urban public subjects, 6.8% in Cholesterol Center referrals, 13.9% in depressed patients, and 20% in cardiac catheterization patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Cholesterol↗
Cholesterol guidelines, lipoprotein cholesterol levels, and triglyceride levels: potential for misclassification of coronary heart disease risk.
By using National Cholesterol Education Program guidelines for serum cholesterol (less than 200 mg/dl is designated "desirable," and 200 to 239 mg/dl is designated "borderline-high," and greater than or equal to 240 mg/dl is designated "high"), low-density and high-density lipoprotein (LDL, HDL) cholesterol levels and triglyceride levels were quantitated in 897 self-referred fasting subjects to assess the potential for coronary risk misclassification. With cholesterol less than 200 mg/dl, misclassification was arbitrarily identified by an LDL level greater than or equal to the 75th percentile, a triglyceride level greater than or equal to the 90th percentile, or an HDL level less than or equal to the 10th percentile. With the cholesterol level in the 200 to 239 mg/dl range, misclassification was identified by an LDL level greater than or equal to the 75th percentile, a triglyceride level greater than or equal to the 90th percentile, and an HDL level less than or equal to the 10th percentile or greater than or equal to the 90th percentile (or both). With a cholesterol level greater than or equal to 240 mg/dl, misclassification was identified by an HDL level less than or equal to the 10th percentile, or greater than or equal to the 90th percentile. With the cholesterol level less than 200 mg/dl, misclassification is rare, occurring in 14.5% of the subjects. With the cholesterol level in the 200 to 239 mg/dl range, and greater than or equal to 240 mg/dl, misclassification occurred in 46.7% and 17.6% of the subjects, respectively. The importance of routine lipoprotein analysis when the cholesterol level is greater than or equal to 240 mg/dl is emphasized by the finding that 65% of the subjects in this category had top quartile LDL levels, 8% had bottom decile HDL levels, and 30% had top decile triglyceride levels. To avoid misclassification, fasting HDL, LDL, and triglyceride levels should probably be measured in all subjects with screening cholesterol levels greater than or equal to 200. There is remarkably little misclassification with top quartile LDL or bottom decile HDL levels (or both) when the cholesterol level is less than 200 mg/dl.
Adolescent↗
Know your cholesterol: population screening.
To facilitate the goal that all adult Americans know their total serum cholesterol levels, our specific aim was to evaluate the effectiveness, practicality, and cost of total cholesterol sampling in nonfasting self-referred subjects with use of venous blood and mailed results (n = 3844), and to compare these results with capillary blood total cholesterol levels (n = 1167), with immediate turnaround. We used consensus cut points of total cholesterol levels greater than 200, greater than 220, and greater than 240 mg/dl for moderate risk of coronary heart disease and greater than 220, greater than 240, and greater than 260 for high risk for aged 20 through 29, 30 through 39, and greater than 40 years. Total cholesterol level was in the moderate- or high-risk range in 45% and 37% of the venous and capillary cohorts, respectively. Median venous and capillary total cholesterol values were approximately 20 and 10 mg/dl greater than the total cholesterol values in the Lipid Research Clinics Prevalence Study, a difference contributed to by nonfasting versus fasting conditions, use of serum versus plasma, and self-referral bias for subjects with a family history of premature coronary heart disease. The cost per subject in the venous and capillary studies was $5.09 and $7.12 respectively, and $11.40 and $ 18.63 for each subject in the moderate- to high-risk range. Resampling with the subject fasting and follow-up were stressed, and were made available for moderate- and high-risk subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗