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Physicians' perspectives on cholesterol and heart disease
C E O'Keefe1, D F Hahn, N M Betts
1Department of Nutritional Science and Hospitality Management, University of Nebraska, Lincoln 68583.
Insights
Physicians recognize the importance of lowering high serum cholesterol for heart health but often underestimate its impact compared to blood pressure or smoking cessation. Many believe diet counseling is their responsibility, despite limited training.
Area of Science:
- Cardiology
- Preventive Medicine
- Nutrition Science
Background:
- Elevated serum cholesterol is a significant risk factor for heart disease.
- Physician attitudes and practices influence patient adherence to cholesterol-lowering strategies.
- Nutrition counseling plays a vital role in managing hypercholesterolemia.
Purpose of the Study:
- To survey Midwestern physicians' attitudes and practices regarding elevated serum cholesterol.
- To assess physician utilization of nutrition counseling referrals.
- To understand physician preparedness and perceived responsibility for dietary advice.
Main Methods:
- A questionnaire survey was mailed to 4,000 Midwestern physicians.
- Data collected from 633 respondents on their views and actions concerning cholesterol management.
- Analysis of physician-reported thresholds for initiating diet and drug therapy.
Main Results:
- 68% of physicians believed lowering cholesterol impacts heart disease, yet valued it less than blood pressure or smoking cessation.
- Diet therapy was initiated for serum cholesterol between 5.70-6.20 mmol/L; drug therapy between 7.80-8.25 mmol/L.
- Most physicians felt prepared for diet counseling despite inadequate medical school training and limited access to registered dietitians.
Conclusions:
- Physicians perceive a need for dietary intervention in cholesterol management but may require enhanced support and resources.
- The low response rate suggests a potential bias towards physicians with a strong interest in the topic.
- Registered dietitians should proactively market their services to physicians and patients to improve cholesterol reduction efforts.
Abstract:
In early spring of 1988, questionnaires were mailed to 4,000 Midwestern physicians to survey their attitudes and practices regarding elevated serum cholesterol and their use of referrals for nutrition counseling; 633 physicians responded. Sixty-eight percent of the physicians thought that reducing high serum cholesterol levels would substantially affect heart disease; however, physicians attributed considerably less preventive value to reducing the cholesterol level than to reducing blood pressure (80.3%) or ceasing smoking (90.0%). The range of serum cholesterol for which diet therapy was most frequently initiated was 5.70 to 6.20 mmol/L. The most frequent range for initiation of drug therapy was 7.80 to 8.25 mmol/L. The physicians reported that although their medical school training did not prepare them adequately for providing diet counseling, they did feel prepared to provide, and were successful in, counseling on diet modifications for reducing serum cholesterol. Few (10%) of the total sample reported having registered dietitians available for dietary counseling, and most (88.8%) believed that it is the physician's responsibility to provide such counseling. Although the low response rate limits the conclusions of the survey, it is likely that those physicians most interested in the topic responded. We conclude that registered dietitians should explore the need for their special services further. More aggressive marketing of dietetic services could benefit both physicians and patients in the campaign to reduce serum cholesterol.