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[Cholesterol determination in ambulatory general practice within the scope of the Brugg/AG quality circle]
1Departement für Innere Medizin, Medizinische Poliklinik, Universitätsspital Zürich. leder.pema@pop.agri.ch
Insights
Physician cholesterol testing behavior varies, with testing frequency increasing alongside cardiovascular risk factors. Routine testing of HDL cholesterol and serum lipids in patients with arteriosclerotic disease is recommended for better risk assessment and treatment.
Area of Science:
- Cardiology and Public Health
- Clinical Practice and Physician Behavior
Context:
- Physician cholesterol testing practices were evaluated in the Brugg region, Aargau, involving 12 physicians and 1183 patient files.
- Previous studies (45, WOSCOP, LIPID, CARE) prompted a re-evaluation of physician "cholesterol testing behavior."
Purpose:
- To analyze current physician practices regarding cholesterol testing and identify variations in evaluating cardiovascular risk factors.
- To assess the correlation between patient risk factors, existing arteriosclerotic conditions, and the frequency of lipid level testing.
- To determine the appropriateness of therapeutic interventions based on cholesterol levels in patients with established cardiovascular disease.
Summary:
- Only 61.2% of patients had their cholesterol levels checked within five years, with significant physician variability in testing all three lipid values (total cholesterol, HDL, triglycerides).
- Testing frequency increased with the number of cardiovascular risk factors and arteriosclerotic secondary illnesses, but was lower in smokers and inactive individuals.
- Therapeutic interventions primarily involved dietary counseling; lipid-lowering medication was underutilized, especially in patients with peripheral occlusive arterial disease despite elevated cholesterol.
Impact:
- Recommends routine testing of HDL cholesterol alongside total cholesterol for accurate cardiovascular risk assessment.
- Highlights the need for clearer definitions of risk factors like lack of exercise in clinical practice.
- Emphasizes routine serum lipid testing and timely therapeutic intervention for patients with manifest arteriosclerotic disease.
Abstract:
Findings of studies designated by the acronyms 45, WOSCOP, LIPID and CARE have provided data that led physicians to rethink their "cholesterol testing behavior." Twelve physicians participated in a study conducted in cooperation with the quality circle of the Brugg region in Aargau. Each doctor collected data from the files of 100 patients and filled in a questionnaire. Cardiovascular risk factors and arteriosclerotic secondary illnesses were compiled along with demographic data. Moreover, information was gathered on whether the patient's cholesterol levels had been checked within the last five years. In total, 1183 questionnaires were evaluated, comprising 691 women and 492 men with an average age of 48.6 years. Cholesterol levels had been determined within the last five years in 61.2%. The individual testing behavior of the physicians varied. One-third tested all three blood lipid values (total cholesterol, HDL and triglyzerides) with an equivalent frequency. By contrast, one-third primarily only determined total cholesterol. The last one-third mostly tested total cholesterol and triglyzeride levels. The frequency of serum lipid tests increased proportionally to the number of risk factors. Cholesterol levels were tested less frequently (approx. 55%) in smokers and patients who never practiced sports than in patients with other risk factors (approx. 85%). The testing rate increased proportionally to the increasing number of arteriosclerotic secondary illnesses, but did not reach the one-hundred percent mark until 3 secondary illnesses were involved. Dietary counseling was the primary therapeutic intervention; medication was prescribed with a much rarer frequency. Although 75% of the patients with arteriosclerotic secondary illnesses had measurably higher cholesterol levels (> 5.2 mm/l), approx. one-third of the patients with coronary heart disease received therapy with cholesterol-lowering drugs as compared to only 16% of the patients with peripheral occlusive arterial disease. The conclusions that we can draw from these results for clinical practice are: if cholesterol levels are to be determined in order to evaluate a patient's cardiovascular risk, HDL cholesterol levels should also be tested since the ratio of these two values is a good predictor. To date, triglyzeride levels have not been identified as relevant risk factors for vascular events. Physicians evaluated the other risk factors variably, in particular with regard to obesity. For clinical practice, the potential risk factor of lack of exercise should be defined more accurately. In patients with clinically manifest arteriosclerotic secondary illnesses, serum lipids should be tested routinely and appropriate therapy induced when required.