High cholesterol under treated in many Americans

NEW YORK (Reuters Health) - A US study on cholesterol released today contains both good and bad news:

The good news: Between 1999 and 2006, the number of adults in the US with high levels of artery-clogging LDL cholesterol, the "bad" cholesterol, decreased by about one-third.

The bad news: A high percentage of adults still are not being screened or treated for high cholesterol levels, putting their health in jeopardy.

Adults at greatest risk for heart attack and other heart-related "events" continue to have the highest prevalence of high LDL cholesterol, Dr. Elena V. Kuklina and associates at the US Centers for Disease Control and Prevention in Atlanta found.

The researchers studied trends in the prevalence of screening, current use of cholesterol-lowering medication, and high LDL cholesterol levels across four periods: 1999-2000, 2001-2002, 2003-2004, and 2005-2006. Overall, there examined data on more than 7,000 adults.

Between 1999-2000 and 2005-2006, the prevalence of high LDL cholesterol levels fell from about 32 percent to 21 percent, the investigators report in Wednesday's edition JAMA (Journal of the American Medical Association).

The prevalence of high LDL cholesterol varied significantly by risk category, however. In 2005-2006, the prevalence high LDL-cholesterol was 59 percent in individuals at high risk for heart-related events, namely those with a history of heart disease, chest pain, heart attack, stroke or diabetes.

The prevalence of high LDL cholesterol was 30 percent in those at medium risk for heart problems and 11 percent in those at low risk. Individuals were stratified as medium or low risk depending on their number of such risk factors as cigarette smoking, high blood pressure, family history of heart problems, and LDL and "good" HDL cholesterol levels.

In the high-risk group, more than 35 percent had not been screened for high cholesterol in the last 5 years and nearly 40 percent were either untreated or inadequately treated for high cholesterol. Roughly 20 percent of high-risk subjects were candidates for statins or other cholesterol-lowering therapy but were not receiving it.

Overall cholesterol screening rates did not change between the first cycle and the most recent one, remaining at less than 70 percent.

Kuklina's group attributes their findings in part to the complexity of current guidelines for cholesterol screening and treatment. Moreover, they point out that a doctors choice of specific guidelines is often determined by the patient's insurance policy.

Drs. J. Michael Gaziano and Thomas A. Gaziano, from Brigham and Women's Hospital, Boston, suggest in an editorial that switching to a simplified risk-based approach could increase the number of patients receiving appropriate cholesterol-lowering-therapy.

In a second editorial, Dr. Aroon D. Hingorani from University College London, UK, and Dr. Bruce M. Psaty from the University of Washington, Seattle, note that one option would be to offer a statin to all adults over a specific age threshold.

SOURCE: Journal of the American Medical Association, November 18, 2009.