Is cholesterol education dangerously flawed?
Experts warn of serious gap between patients, docs
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 City-based Citizens for Public Action on Blood Pressure and Cholesterol.
One encouraging finding 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 their cholesterol level, and 89% of them had heard of good and bad cholesterol.
Hey, can we talk?
Nevertheless, other findings of the surveys were less encouraging:
• Only 42% of physicians reported spending "a lot" of time discussing low-density lipo- protein (LDL, or "bad" cholesterol) with their patients.
• Only 31% said they spend a lot of time discussing high-density lipoprotein (HDL, or "good" cholesterol) with their patients.
• An even smaller percentage, 12%, spent "much time" discussing triglycerides.
• Three-quarters of physicians said less than half of their high-cholesterol patients are on some form of cholesterol therapy.
• One-third of physicians said they believe 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.
• Only 9% of patients surveyed knew their LDL level.
• Eleven percent knew their HDL level.
• Twelve percent knew their triglyceride level.
• Three percent knew their Lp(a) level.
• Almost half (45%) of patients with high cholesterol said their physicians had not discussed with them all the lipids that factor into managing total cholesterol.
• Only 6% of high-cholesterol patients said their doctor had discussed achieving numerical targets for HDLs or triglycerides.
• About one-quarter of the patients said they were taking or had taken medication to manage their cholesterol levels.
Most alarming to Gotto is the fact that 45% of patients with high cholesterol reported "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 the fact that, although 84% of physicians say they routinely discuss LDL with their patients, and most discuss HDL and triglycerides as well, a full 45% of patients say 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 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.
[Editor’s note: For more information on lipids, contact: Antonio Gotto, MD, DPhil, Cornell University Medical College, 1300 York Ave., F105, New York, NY 10021. Telephone: (212) 746-6005.]
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