State Heart Disease and Stroke Prevention Programs Address High Blood Cholesterol

High blood cholesterol is a major modifiable risk factor for heart disease, the leading cause of death in the United States.¹ A 10% decrease in total blood cholesterol levels can reduce the incidence of heart disease by as much as 30%.²

Cost is an important issue when referring to heart disease and stroke. In 2007, the American Heart Association estimates that the direct and indirect costs for cardiovascular disease will be $431.8 billion.³ This estimate includes costs of more than $151.6 billion annually for coronary heart disease. Workplaces are greatly affected with indirect costs that are estimated to top $148.6 billion in 2007, with those indirect costs relating to lost productivity. Thus, reducing LDL (bad) cholesterol can be cost effective in three ways: direct economic savings from decreased hospital and ambulatory services, preventing coronary heart disease mortality, and preventing the disability, distress, and pain associated with coronary heart disease.⁴

Two of the national health objectives for the year 2010 are to reduce to 17% the percentage of adults aged 20 years or older with total blood cholesterol levels of greater or equal to 240 mg/dL or higher, which is considered high risk; and to increase to 80% the percentage of adults who had their blood cholesterol checked during the preceding 5 years.⁵ An overall national health goal is to eliminate racial/ethnic and other disparities in all health outcomes, including high blood cholesterol.⁵

The proportion of American adults aged 20 years and older having high blood cholesterol levels of 240 mg/dL or higher decreased from 20.8% during 1988–1994 to 16.7% during 2001–2004.⁶ This decrease is likely due to the increased use of cholesterol-lowering medications.⁶ Despite this improvement, from 1991–2003, there was an increase in the proportion of United States participants aged 20 years and older who reported having been told that their blood cholesterol was high.⁷ Furthermore, from 1999–2000, more than 50% (107 million) of adult Americans, particularly women, had blood cholesterol levels of 200 mg/dL or higher, which is above desirable levels (see table 1).⁸

During 1991–2003, the percentage of adults in the United States screened within 5 years increased from 67.5% to 73.1%.⁷ Only a few states (Washington, D.C. and Massachusetts) had achieved the Healthy People 2010 objective of 80% prevalence. Most important, there are racial and ethnic differences in cholesterol screening and awareness. In 2003, Hispanics and Asians/Pacific Islanders, and younger adults (20–44 years), had the lowest prevalence of cholesterol screening, 65.5%, 69.6%, and 59.8%, respectively.⁷ Although the prevalence of cholesterol screening during 1991–2003 was higher among women than men, twice as many men as women were told they had high blood cholesterol.⁷

Efforts to increase the number of effective public health campaigns, and access to affordable treatment are needed to raise awareness and increase screening and control of high blood cholesterol, especially among women, Hispanics, Asian/Pacific Islanders, and younger adults. Lowering high blood cholesterol can reduce the risk for developing or dying from heart disease, including heart attacks; however, less than half of persons who qualify for any kind of lipid treatment for risk reduction are receiving it.⁴

Blood cholesterol levels can be lowered through dietary changes, increased physical activity, weight control, drug therapy, or a combination of these.⁴ The National Cholesterol Education Program (NCEP) recommends that adults aged 20 years and older have their blood cholesterol levels measured at least once every 5 years.⁴

A lipoprotein profile is performed to measure different components of total cholesterol as well as triglycerides (another type of fatty substance that increases risk for heart disease). See NCEP guidelines for treatment recommendations.

State Heart Disease and Stroke Prevention Programs Take Action

State Health Departments work to prevent and control high blood cholesterol and reduce the burden of heart disease and stroke by promoting activities that can be implemented in health care, work sites, communities, and schools. For example, a state program might—

• Promote policy development, training, and system changes (e.g., electronic medical records, automated prescription systems, and paper or electronic reminders) to assist health care practitioners to adhere to treatment protocols consistent with national guidelines for preventing and controlling high blood cholesterol.
• Partner with organizations to assure that detection and follow–up services are available for controlling high cholesterol in various settings, including health care, work site, and community.
• Promote the use of clinical care teams that include health educators to assure consistent screening, detection, risk–factor education, medication monitoring, and follow–up to prevent and control high blood cholesterol.
• Educate the public using simple and frequent messages that high blood cholesterol is a major modifiable risk factor for heart disease and stroke, and that having one’s blood cholesterol checked is an important first step in identifying and controlling high blood cholesterol and reducing the risk of heart disease and stroke.
• Collaborate on professional medical education, self–care workshops, policy interventions, and incentives to improve detection and control of high blood cholesterol.
• Encourage health care insurance coverage for blood cholesterol screening, treatment, and control, as well as rehabilitation services for heart attack and stroke survivors.
• Partner with other agencies to establish organizational policies and environmental interventions that support healthy lifestyles including access to screening, low–cost healthy food choices, smoke–free facilities, stress management options, and places for physical activity.

References

1. U.S. Department of Health and Human Services. A Public Health Action Plan to Prevent Heart Disease and Stroke. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2003.
2. Cohen JD. A Population-based approach to cholesterol control. Am J Med 1997;102:23–5.
3. American Heart Association. Heart Disease and Stroke Statistics: 2007 Update. Dallas (TX): American Heart Association; 2007.
4. National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III). Circulation 2002;106:3143–3421.
5. US Department of Health and Human Services. Healthy People 2010 (conference ed., 2 vols.). Washington, DC: US Department of Health and Human Services; 2000.
6. National Center for Health Statistics. Health, United States, 2006 with Chartbook on Trends in the Health of Americans. Hyattsville, MD: US Department of Health and Human Services, CDC; 2006.
7. CDC. Trends in cholesterol screening and awareness of high blood cholesterol—United States, 1991–2003, MMWR 2005;54(35):865–870.
8. Ford ES, Mokdad AH, Giles WH, Mensah GA. Serum total cholesterol concentrations and awareness, treatment, and control of hypercholesterolemia among U.S. adults: Findings from the National Health and Nutrition Examination Survey, 1999 to 2000. Circulation 2003;107:2185–9.