Dyslipidemia in veterans. Multiple risk factors may break the bank

The National Cholesterol Education Program guidelines for treatment of high cholesterol levels especially target patients who have multiple risk factors for coronary heart disease. Veterans have an increased prevalence of smoking, are predominantly male, and may have higher rates of other risk factors than other groups; therefore, they may require more aggressive screening and treatment for dyslipidemias. To assess the prevalence of cardiac risk factors, current cholesterol screening practices, and the potential impact of the National Cholesterol Education Program guidelines on the Veterans Affairs health care system, we reviewed 185 randomly selected charts of outpatients who were actively receiving follow-up at the Denver (Colo) Veterans Affairs Medical Center. The patients had an average age of 58.3 years and 99.5% were male. Of these patients, 60% had a serum cholesterol level checked within the last 999 days. Nearly all patients (84%) had two or more risk factors noted. The mean cholesterol level was 5.85 mmol/L (226 mg/dL), with 72% of patients having levels above 5.20 mmol/L (200 mg/dL) and 36.1% having levels above 6.20 mmol/L (240 mg/dL). Of patients who had their cholesterol level checked, 69% (77/111) would require lipoprotein analysis by National Cholesterol Education Program guidelines (cholesterol, greater than or equal to 6.20 mmol/L [greater than or equal to 240 mg/dL] or 5.15 to 6.20 mmol/L [200 to 239 mg/dL] with two or more risk factors), yet only 16% (12/77) had lipoprotein analyses done. Extrapolating from these data, the Denver Veteran Affairs Medical Center, which cares for 28,000 patients, has more than 19,000 patients who would need lipoprotein analysis to meet current guidelines. Full evaluation and subsequent treatment of dyslipidemias in veterans would require tremendous financial and manpower commitments.