Performance of the Reflotron in Massachusetts' Model System for Blood Cholesterol Screening Program.

The precision, accuracy, and durability of the Reflotron were evaluated by the Massachusetts Model Systems for Blood Cholesterol Screening Program. Screenings were conducted in diverse community settings over 16 months. Fingerstick samples from 10,428 individuals were tested. None of the four analyzers met the 1992 standards for precision, although two met the 1992 standards for accuracy. More than 40% of Reflotron values differed from the reference laboratory values by upwards of 5%. More than 16% of individuals were misclassified in terms of their risk category. All four instruments malfunctioned during the project.

Reflotron performance in a community screening program: results of the Massachusetts Model Systems for Blood Cholesterol Screening Project.

We evaluated the precision, accuracy, and durability of the Reflotron portable analyzer as part of the National Heart, Lung, and Blood Institute's Model Systems for Blood Cholesterol Screening Program. We conducted screenings in a wide variety of settings in four Massachusetts communities over a 16-month period. Fingerstick samples from 10,428 individuals were tested on the Reflotron at the screening sites. For comparison, we drew venous samples from 972 participants and analyzed them in a reference laboratory, which had met the requirements of the Centers for Disease Control's Lipid Standardization Program. All four Reflotrons tested met the 1988 guidelines for precision and accuracy established by the Laboratory Standardization Panel (LSP) of the National Cholesterol Education Program (NCEP). None of the analyzers consistently met the 1992 LSP standards for precision, although two met the 1992 standards for accuracy. More than 40% of Reflotron values differed from the reference laboratory values by more than 5%. As a consequence, more than 16% of individuals were misclassified in terms of the NCEP risk category into which their Reflotron readings fell. All four instruments malfunctioned at some point during the project, precluding their further usage. We recommend improvements in the precision, accuracy, and durability of this analyzer.

Results of the Massachusetts Model Systems for Blood Cholesterol Screening Project.

OBJECTIVE: --To evaluate the effectiveness of a model blood cholesterol screening program. DESIGN: --Principal components included physician education, community-based screenings, and follow-up. A lay or professional educator provided counseling and referral advice. Half of the subjects with high blood cholesterol levels received a reminder to see their physician. SETTING: --135 sites in four Massachusetts communities. PARTICIPANTS: --10,428 adults. Males, the young, the poor, the less educated, and minorities were underrepresented. MAIN OUTCOME MEASURES: --Referral completion rates, blood cholesterol changes. RESULTS: --51.5% of those referred had visited their physicians within 2 to 4 months, increasing to 65.6% within 6 to 12 months. Older age (odds ratio [OR], 1.17 per additional decade), more education (OR, 1.17 per additional level), higher blood cholesterol levels (OR, 1.19 per additional 0.51 mmol/L), previous knowledge of level (OR, 1.34), and receiving a reminder (OR, 1.24) were significantly associated with greater likelihood of referral completion, whereas the type of educator providing counseling was not. Physicians had remeasured the blood cholesterol level of 76% of those seen, given dietary counseling to 70%, and prescribed medication to 15%. Significant changes in dietary fat were reported by both compliers and noncompliers with advice to follow up with their physicians. Six months after screening, blood cholesterol levels were 3.6% lower in noncompliers, 4.4% lower in compliers not taking cholesterol-lowering medications, and 8.8% in compliers taking such medications. CONCLUSIONS: --An effective, community-based blood cholesterol screening program can attract diverse populations and can result in most participants with high levels following up with their physicians, making dietary changes, and lowering their cholesterol levels. Additional strategies may be needed to attract underrepresented groups and to reduce the apparent overuse of cholesterol-lowering medications.

Report of the New England Task Force on Reducing Heart Disease and Stroke Risk.

Five years ago, a task force on reducing risk for heart disease and stroke was established by the six New England States. The task force included representatives from State public health departments, academia, the corporate sector, and voluntary organizations. This article is the final report of the task force. Heart disease and cerebrovascular disease are major causes of mortality in the New England region. Heart disease causes nearly 40 percent of all deaths in each of the six States and cerebrovascular disease, 7 percent of the deaths. Major risk factors for ischemic heart disease that have been identified--elevated serum cholesterol, high blood pressure, and cigarette smoking--are caused largely by lifestyle behaviors. Similarly, cerebrovascular disease results largely from uncontrolled high blood pressure, much of which is attributable to unhealthy lifestyle behaviors. In a series of studies evidence has accumulated that the reduction or elimination of these risk factors results in a decline in mortality rates. Many intervention programs have been mounted in the region, but there has been no population-wide effort to attack these risk factors. The task force proposed a broad range of activities for New Englanders at sites in the community and in health facilities. These activities would promote not smoking, exercising regularly, and maintaining desirable levels of serum cholesterol and blood pressure.