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Measuring serum total cholesterol: do vascular surgeons know what they are doing?
L D Wijesinghe1, L Gamage, D C Berridge
1Department of Vascular and Endovascular Surgery, St James's University Hospital, Leeds.
Insights
Vascular surgeons frequently measure total cholesterol (TC), but management of high cholesterol varies significantly. Many doubt its benefit for claudication, despite evidence for cardiovascular risk reduction.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Clinical Practice
Background:
- Elevated serum total cholesterol (TC) is a recognized risk factor for coronary and peripheral vascular diseases.
- Statins have demonstrated efficacy in lowering TC and reducing cardiovascular events.
- Current practices and beliefs among vascular surgeons regarding hypercholesterolemia management are not well-understood.
Purpose of the Study:
- To investigate the measurement and management of raised TC by vascular surgeons in Great Britain and Ireland.
- To assess vascular surgeons' beliefs about the benefits of lowering TC for cardiovascular outcomes and claudication.
Main Methods:
- A questionnaire was distributed to members of the Vascular Surgical Society of Great Britain and Ireland.
- The survey addressed TC measurement, normal levels, and thresholds for intervention.
- Surgeons' opinions on the impact of TC lowering on coronary mortality and claudication were solicited.
Main Results:
- A 67% response rate was achieved from 374 distributed questionnaires.
- Over 90% of respondents routinely measured TC, with 5.5 mmol/l commonly considered normal.
- Significant variation existed in the TC levels triggering drug therapy or specialist referral (5.5–7.5 mmol/l).
- While 62% believed lowering TC improved coronary mortality, only 26% felt it prevented claudication worsening.
- Nearly one-fifth of surgeons doubted the benefit of TC lowering for coronary mortality.
Conclusions:
- Most vascular surgeons measure TC, but treatment thresholds and approaches are inconsistent and often deviate from guidelines.
- There is limited surgeon confidence in the benefits of TC reduction for peripheral artery disease symptoms like claudication.
- Further education and guideline dissemination may be necessary to align surgical practice with evidence-based hypercholesterolemia management.
Abstract:
Raised serum total cholesterol (TC) is an accepted risk factor for both coronary and peripheral vascular disease and three landmark trials have shown the benefit of lowering TC using statins. Vascular surgeons tend to measure TC, but little is known about how they manage hypercholesterolaemia or whether they believe treatment will be of benefit. A questionnaire was sent to listed members of the Vascular Surgical Society of Great Britain and Ireland seeking responses to a range of questions on the measurement and management of raised TC. In all, 374 questionnaires were sent out. The response rate was 67%. Over 90% of respondents said they measured TC and considered a level below 5.5 mmol/l as normal. The cut-off for initiating drug therapy, referral to a dietician or to a lipid specialist varied from 5.5 to 7.5 mmol/l. Most (62%) believed that lowering TC improved coronary mortality, but fewer (26%) that it prevented worsening of claudication. Although most vascular surgeons check for raised TC, the level at which treatment begins and the form it takes varies; in many cases being at odds with recommendations. Few surgeons are convinced of the benefits of lowering TC for claudication and nearly one-fifth do not believe it improves coronary mortality.