Studies of cholesterol methodology and application to population surveys.

THE PRESENT INTEREST in the relationship of cholesterol to atherosclerosis has increased the frequency with which the determination of serum cholesterol is utilized as a diagnostic aid. Two general lines of evidence support the conclusion that most of the currently available methods of cholesterol determination are not entirely satisfactory in all laboratories. First, there are a large number of methods which have been and are presently being proposed for this determination (1). Second, there is an apparent inability of laboratories to achieve as high a degree of accuracy in the determination of cholesterol as in the determination of some other substances (2). The variability of cholesterol values reported from different laboratories may arise from the use of different methods in each laboratory or from some more subtle difference in the conditions under which the reported values are obtained. In order to investigate the former in the absence of the latter, 7 different methods for the determination of cholesterol were evaluated. Studies by Dawber et at. (3) in Framingham, Mass., have indicated that the probability of arteriosclerotic heart disease (ASHD), code 420 WHO (4) is highest among the segment of the population which may be characterized as having hypercholesteremia, hypertension, and obesity. A survey of 3992 longshoremen in the San Francisco Bay Area, previously reported by Buechley et at. (5) did not show obesity to be a factor associated with increased incidence of ASHD.