Dyslipidemia refers to a range of health conditions associated changes in the concentration of lipids in the blood caused by changes in fat metabolism in the body. Hypercholesterolemia, hyperlipidemia and mixed dyslipidemia are the conditions generalized as dyslipidemia. Hypercholesterolemia is caused by high concentrations of cholesterol in the blood and these may include elevated low-density lipoproteins (LDL). Hypercholesterolemia can be either familial (associated with single genetic defect) or non-familial (caused by the interactions of several genes due to other risk factors such as sedentary lifestyle, and, tobacco smoking. Most individuals with Hypercholesterolemia do not exhibit any symptoms due to moderated cholesterol elevation. Symptoms are however identifiable in severe elevation cases. Mixed dyslipidemia as the name suggests, is a combination of elevated of both low-density lipoproteins and triglycerides hence leading to low concentrations of high-density lipoproteins (Thompson, 2004) .
According to WHO, (n.d.) , 33% of ischemic heart disease is related to elevated cholesterol. Elevated cholesterol accounts for about 2.6 million lives globally which is about 4.5% of the total deaths and accounts for about 29.7 million disability-adjusted life years in 2008. In 2016, the numbers increased to 4.4 million deaths globally and 93.8 million disability-adjusted life-years (Hay et al., 2017) . This is an indication of a steady increase in the condition and may reach overwhelming levels in the future if measures are not keenly taken. Based on the number of diseases and conditions that affect adults, the mortality represented is obviously high for a single disease hence early preventive measures have to be taken.
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Dyslipidemia is associated with coronary heart disease (CHD), coronary artery disease (CAD) and other cardiovascular conditions. Dyslipidemia is also associated with incidences of stroke. These diseases are very common among the aging and so is dyslipidemia (Ryan, Heath & Cook, 2018) . Dyslipidemia occurs majorly among individuals above 50 years of age except for familial Hypercholesterolemia which may occur at an earlier stage in life. Preventive screening for dyslipidemia is varied on age and sex. Preventive screening for women is recommended to begin at about 45 years while for men at 35 years. Screening for women can begin as early as being 20 years of age when exposed to certain specific risk factors such as smoking. Individuals with family members suffering from familial Hypercholesterolemia before the age of 50 are eligible for early adult screening. Individuals with evidence of cardiovascular disease risk factors such as smoking, obesity, insufficient exercise, and, diabetes type 2 among others are more eligible for screening. Any individuals presenting any of the risk factors associated with dyslipidemia should be recommended for screening (USPSTF, 2009) . Notably, an individual presenting with multiple risk factors are most likely to suffer the condition and is therefore highly recommended for screening. Medically, individuals with diabetes, individual history of coronary heart diseases or non-coronary atherosclerosis, family history of cardiovascular diseases before attaining the age of 50 in males and 60 years in female relatives, use of tobacco, hypertension, obesity (BMI greater than or equal to 30Kg per M 2 ) are eligible for recommended screening at the facility (Ryan, Heath & Cook, 2018) .
The most preferred screening for dyslipidemia is the measurement of total cholesterol and high-density lipoprotein levels on both fasting and non-fasting samples. Some medical practitioners also recommend the measurement of levels of triglycerides in blood as part of the screening tests however, the benefits of including such tests in the routine screening of dyslipidemia have not been validated. As a healthcare provider, it is therefore recommended to use the generally accepted methods and techniques of cholesterol measurement for dyslipidemia. In case of abnormal test results during screening, a confirmatory test is recommended. Confirmatory testing should be conducted using a different sample and on a separate occasion in order to achieve desired results (USPSTF, 2009) . On some occasions, however, due to several factors at a medical facility, the available medical laboratory may not be able to provide reliable measurements of high-density lipoproteins, measuring total cholesterol alone is acceptable. This may occur due to the level or type of health facility that influences the types of accessories and devices at the disposal of medical practitioners at the various medical laboratories in healthcare facilities (USPSTF, 2009) . There are also more expensive screening procedures such as the measurement of low-density lipoproteins using a fasting sample which are more accurate and precise. Whenever possible, in patients with dyslipidemia who are identified through screening, they should also have a full lipoprotein analysis (USPSTF, 2009) . This, however, may not be possible due to variations in healthcare facilities and the ability of the patient to afford such services. According to Dehmer, Maciosek, LaFrance & Flottemesch, (2017), the health impact of cholesterol treatment and screening is 14,300 QALYs while its cost effectiveness is $33,800 QALYs. This is an indication of high economic benefits arising from screening.
There are not yet any universally agreed intervals for screening of dyslipidemia. Intervals for screening are majorly based on local guidelines and expert or provider opinions. The most commonly used interval is five years or shorter for individuals with the condition and those exhibiting high-risk factors and longer intervals for individuals less predisposed to risk factors or those who have continuously had normal lipid levels during screening. The age at which one should stop screening has not yet been established. Screening is however recommended for older or aging individuals who have never been screened at all. Continuous screening is also discouraged among the aged since lipid levels are reportedly less likely to increase once an individual reaches 65 years (USPSTF, 2009) .
Screening for dyslipidemia or any other type of screening has to main objectives; identifying individuals with the condition; or confirming the nonexistence of the condition. Identifying individuals with the condition is supposed to be followed by treatment. Reports indicate that early treatment aimed at lowering lipid levels reduces the chances of coronary heart disease by about 40% (USPSTF, 2009) . Early screening is also known to identify asymptomatic individuals who might unexpectedly suffer coronary incidences. Having negative results translates into minimizing exposure to risk factors through the strengthening of preventive strategies.
References
Hay, S., Abajobir, A., Abate, K., Abbafati, C., Abbas, K., & Abd-Allah, F. et al. (2017). Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet , 390 (10100), 1260-1344. DOI: 10.1016/s0140-6736(17)32130-x
Dehmer, S., Maciosek, M., LaFrance, A., & Flottemesch, T. (2017). Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention. The Annals Of Family Medicine , 15 (1), 23-36. DOI: 10.1370/afm.2015
Ryan, A., Heath, S., & Cook, P. (2018). Dyslipidemia and cardiovascular risk. BMJ , k835. DOI: 10.1136/bmj.k835
Thompson, G. (2004). Management of dyslipidemia. Heart , 90 (8), 949-955. DOI: 10.1136/hrt.2003.021287
USPSTF. (2009). Screening for Lipid Disorders in Adults: Recommendation Statement. Retrieved 18 December 2019, from https://www.aafp.org/afp/2009/1201/p1273.html
WHO. Raised cholesterol; Situation and trends. Retrieved 18 December 2019, from https://www.who.int/gho/ncd/risk_factors/cholesterol_text/en/
