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Comprehensive cholesterol screening should be a regular part of your medical checkups. But should you also test cholesterol at home with a kit available from the pharmacy or via the Internet?
Our advice, after testing five widely sold kits: Don't bother. Two were inaccurate. Three test only for total cholesterol and so provide less information than most people need. All require you to draw a relatively large amount of blood. And none save you much money. We compared the five kits with results from a hospital lab, using blood from staff volunteers. Here's what we found:
The CholesTrak, First Check, and Home Access kits (the same kit from three companies) were judged good; all readings varied no more than 15 percent from those at the hospital. However, those three kits measure only total cholesterol, which isn't necessarily the most meaningful indicator. A full lipid profile, also measuring HDL ("good") cholesterol and triglycerides, is far more informative. A full profile yields the most important figure, LDL ("bad") cholesterol levels.
The CardioChek (which costs $185) and the Biosafe Cholesterol Panel mail-in kit deliver a full lipid profile. But both yielded results that were often wide of the mark.
The CardioChek requires you to draw blood three times from your fingers for a complete lipid profile. With the others, you need only one finger prick. But they all require 45 to 100 micro liters of blood. Drawing the necessary blood can be difficult, painful, and messy. By contrast a blood-glucose test needs only 1-3 micro liters.
The cost of an at-home test ranges from $14 for the First Check to about $30 for the Biosafe Cholesterol Panel. A full profile at the doctor's office and any needed follow-up tests will cost about $30 each. They're usually covered by health insurance. The home kits aren't covered.
HEAT AGGRESSIVELY-BUT SAFELY
To reach LDL levels below 100 mg/dl, patients will likely have to take cholesterol-lowering medications known as "statins", either alone or in combination with other drugs that canal so reduce LDL levels, as well as improve other risk factors for heart disease such as a low level of the "g ood" HDL cholesterol. While cholesterol drugs are generally quite safe, their risks rise at higher doses. And little is known about the long-term safety of the newer drugs, specifically ezetimibe (Zetia) and rosuvastatin (Crestor). So people taking such drugs need to know the potential adverse effects and contact their doctor at the first sign of any problem. Moreover, taking the maximum recommended dose may be unwise. Studies show that the highest doses often provide minimal additional benefits while substantially increasing the chance of adverse effects.
Instead, it often makes sense to add a second medication. For example, doubling the dose of a "statin" drug, such as atorvastatin (Lipitor) or lovastatin (Mevacor), on average lowers LDL cholesterol only an additional 6 percent. But adding a complementary medication, such as ezetimibe, can cut it by 17 to 24 percent. A second drug may be appropriate when you have not only a high level of the "bad" LDL cholesterol but also either a low level of the "good," high-density lipoprotein (HDL) cholesterol (which drags cholesterol out of the arteries) or a high level of triglycerides, fats in the blood that elevate coronary risk.
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