Cholesterol Screening: the Gold Effect?

This paper explores the concept of the ‘Gold Effect’ in relation to the use of serum cholesterol measurement as a screening test for cardiovascular disease. The Gold Effect explains the phenomenon of the process by which an idea comes to be held as a generally accepted truth. In this paper we argue that cholesterol screening is the product of the Gold Effect. Screening tests need to be sufficiently robust as an indicator of risk and thus their evidence base should be clear and uncontested. While there has been a long standing debate about the link between high cholesterol and cardiovascular disease and, in particular, the use of statins as the main approach to lowering cholesterol levels, serum cholesterol measurement and lowering levels of cholesterol are widely accepted as NHS interventions and are financially incentivised. We start by discussing what cholesterol is and how it is screened for in the UK. We then go on to examine the evidence for using cholesterol as a risk marker for cardiovascular disease. We then discuss the research on reducing cholesterol levels through diet and by using statins. We finish by discussing the implications of this analysis and questioning why cholesterol is routinely screened for and why so much emphasis is placed on cholesterol reduction arguing that at the root of this approach there is a misconception about the relationship between fat and cholesterol and about the role of cholesterol in cardiovascular disease.