Cholesterol education dangerously flawed
Two recent telephone surveys of patients with high cholesterol and the physicians who treat them reveal a disturbing gap between the education physicians think they’re providing and what patients actually receive.
Results from the surveys, sponsored by Miami-based Kos Pharmaceuticals, Inc. and conducted by the polling firm of Yankelovich Partners, were released at a dyslipidemia roundtable of the New York-based Citizens for Public Action on Blood Pressure and Cholesterol.
One encouraging finding of the study is that 65% of the 200 physicians surveyed reported that they followed the guidelines of either the Dallas-based American Heart Association or the Bethesda, MD-based National Heart, Lung and Blood Institute’s National Cholesterol Education Program when diagnosing and managing elevation of lipids, says Antonio Gotto, MD, the Stephen and Suzanne Weiss, dean and professor of medicine at Cornell University Medical College in New York. In addition, about half of the 500 patients surveyed knew what their cholesterol level was, and 89% of them had heard of good and bad cholesterol.
Nevertheless, other findings of the surveys were less encouraging:
• Only 42% of physicians reported spending "a lot" of time discussing low-density lipoprotein (LDL), or "bad" cholesterol, with their patients.
• Only 31% spend a lot of time discussing high-density lipoprotein (HDL, or "good" cholesterol) with their patients.
• An even smaller number, 12%, spent much time discussing triglycerides.
• Three-quarters of physicians have less than half of their high-cholesterol patients on some form of cholesterol therapy.
• One-third of physicians believe that most or many of their patients know what constitutes high cholesterol.
In fact, however, although 89% of patients had heard of good and bad cholesterol, a majority do not know whether LDLs (63%), HDLs (59%), triglycerides (58%) or Lp(a) (85%) are good or bad cholesterols. In addition:
• Only 9% of patients surveyed know their LDL level.
• Eleven percent know their HDL level.
• Twelve percent know their triglyceride level.
• Three percent know their Lp(a) level.
• Almost half (45%) of patients with high cholesterol say that their physicians have not discussed with them all the lipids that factor into managing total cholesterol.
• Only 6% of high cholesterol patients say that their doctor has discussed achieving numerical targets for HDLs or triglycerides.
• About one-quarter of the patients are taking or have taken medication to manage their cholesterol.
Most alarming to Gotto is the fact that 45% of patients with high cholesterol report that "they aren’t concerned about it in the least. This is disturbing considering that all of these patients have talked to their physicians about their cholesterol level, and have been the target of educational efforts directed toward the significance of elevated cholesterol."
Also disturbing was that, although 84% of physicians say they routinely discuss LDL with their patients, and a majority discuss HDL and triglycerides as well, a full 45% of patients say that they have not talked to their physicians about lipids at all. "Obviously, there’s a disconnect here," Gotto says. "Most likely, the patients either weren’t listening or [the information] wasn’t said in such a way that it made an impression on them."
Gotto adds that recent research makes it clear that measurement of total cholesterol is insufficient to determine risk of heart disease. Awareness of the various components, including LDL, HDL, and triglycerides is key to effective management of cholesterol levels, he says.
[For more information on lipids, contact:
Antonio Gotto, MD, DPhil, Cornell University Medical College, 1300 York Avenue, F105, New York, NY 10021. Telephone: (212) 746-6005.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content