Related Experiment Videos
[Hypercholesterolemia in general practice--2 representative surveys in Switzerland]
P Anliker1, B Burnand, B Janin-Jacquat
1Institut für Sozial- und Präventivmedizin, Universität Zürich.
Insights
General practitioners recognize smoking and high blood pressure as key coronary heart disease risks. Cholesterol levels are third, with therapy initiation decreasing over time.
Area of Science:
- Cardiology
- Public Health
- General Practice
Context:
- Surveys of Swiss general practitioners in 1987 and 1989 identified key risk factors for coronary heart disease.
- Cigarette smoking and high blood pressure were consistently ranked as the most significant factors, with elevated blood cholesterol levels ranking third.
Purpose:
- To investigate the thresholds at which Swiss physicians initiate cholesterol-lowering therapies.
- To examine changes in therapy initiation levels and identify regional differences within Switzerland.
- To understand physician perspectives on the effectiveness and challenges of cholesterol management.
Summary:
- Physicians' initiation levels for diet therapy for high cholesterol decreased significantly between surveys. Median ranges for initiating diet therapy in 1989 varied by age, with lipid-lowering drug initiation occurring at higher levels.
- Therapy initiation levels showed significant decreases within two years, with notable differences observed across Swiss language regions.
- Physicians reported challenges with patient compliance for diet therapy (90%) and insufficient treatment results for both diet and drug interventions in 1989. Side effects of drug treatment were also cited.
Impact:
- Findings highlight evolving clinical practices in cardiovascular risk management among Swiss general practitioners.
- Identifies significant challenges in patient adherence and treatment efficacy for hypercholesterolemia.
- Suggests a need for improved strategies to address compliance issues and enhance the effectiveness of cholesterol-lowering treatments.
Abstract:
Two representative surveys of general practitioners in 1987 and 1989 showed, that cigarette smoking and high blood pressure are considered the most important risk factors for coronary heart disease. Elevated blood cholesterol level rank third. Between the two surveys no significant changes took place. The blood cholesterol level is usually measured at a check-up visit or in presence of another risk factor. Routine measurement is not common. At what level do Swiss physicians initiate a therapy? The median range in 1989 for a diet therapy was 6.2-6.7 mmol/l (240-260 mg%) for a 30 years old person, and 6.7-7.2 mmol/l for a 60 years old person. Lipid-lowering drugs are used at about 1 mmol/l (40 mg%) higher levels and there is less agreement between the physicians. Within two years the levels of initiating therapy decreased significantly. Differences between the three Swiss language regions (german/french/italian) in initiating therapy can be seen. 90% of the physicians mentioned compliance problems with a diet therapy. In 1989 half of the surveyed doctors experienced insufficient results in both diet and drug treatment. Further, compliance problems and side effects of drug treatment are mentioned. Half of the physicians reported having tested their own cholesterol level in the last 12 months. Older physicians are considerably more conscious of high cholesterol levels than younger.