Cholesterol Levels Remain High Despite Education, Medications

November 10, 1997

Cholesterol levels remain high above recommended levels despite widespread education efforts and wider availability of cholesterol-lowering drugs, a physician from the University of Rochester reported today at the annual meeting of the American Heart Association in Orlando.

Sixty-two percent of patients being treated for high cholesterol by primary-care physicians didn't reach recommended targets in a nationwide study of cholesterol levels. The news is even worse for patients who already have coronary heart disease and are at greatest risk of heart attack: Fewer than one out of five patients (18 percent) reached target levels.

"Doctors need to be more aggressive about treating high cholesterol," says Thomas Pearson, Albert D. Kaiser Professor and Chair of the Department of Community and Preventive Medicine. "These are patients who are under a doctor's care, yet the numbers are dismal." Pearson led the study, dubbed L-TAP (Lipid Treatment Assessment Project), which was funded by Parke-Davis, a division of Warner-Lambert Company, and Pfizer Inc.

Pearson and colleagues surveyed 619 primary care physicians around the nation who are among physicians most likely to prescribe cholesterol-lowering drugs. From September 1996 to June 1997, the team analyzed blood samples from 5,601 of those doctors' patients who were being treated for high cholesterol. Scientists measured the level of low-density lipoprotein (LDL), the "bad" cholesterol that builds up in arteries and blocks the flow of blood to the heart. Such blockages contribute to heart disease and other types of cardiovascular disease, which accounts for about one-half of all deaths in the U.S. Pearson's team compared the levels to guidelines set by the National Cholesterol Education Program (NCEP), a program coordinated by the National Institutes of Health.

Overall just 38 percent of patients had LDL levels within the recommended ranges. As risk increased, success decreased: 68 percent of patients with fewer than 2 risk factors for cardiovascular disease reached the recommended level of 160 mg/dL or below; 37 percent of patients with 2 or more risk factors reached their target of 130 mg/Dl or below; and just 18 percent of patients with coronary heart disease reached the NCEP- recommended level of 100 mg/dL or below.

Pearson attributes the poor results to several factors: patients not following doctors' orders, confusion over which doctor should take the lead in treating cholesterol levels, disagreement among some physicians about the need for cholesterol testing in certain low-risk groups, and an ignorance of the benefits of cholesterol-lowering medications.

"Many patients don't change their diet or get more exercise even when prompted by their physicians," says Pearson. "Sometimes it's not clear whether the primary care doctor or a specialist should be responsible for bringing down cholesterol. And sometimes doctors start a medication and then call the patient "treated," even though the first dose may not be enough. In short, there are missed opportunities all along the line."

African-Americans were less likely to reach their target goals than their white or Hispanic counterparts. Just 5 percent of African-Americans with coronary heart disease had recommended LDL levels, compared to 18 percent of whites and 21 percent of Hispanics.

The study also showed that, as one might expect, patients who followed their physicians' advice to exercise more or change their diet to include less saturated fat were much more likely to reach recommended cholesterol levels.

"Target levels are supposed to guide physicians and patients in reducing risk, but we still have an alarming gap between treatment targets and treatment success," says Pearson.

University of Rochester

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